Provider Demographics
NPI:1962601161
Name:REYNOLDS, SHELLEY ANN (LPN)
Entity type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:ANN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 ADAMS LN
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2612
Mailing Address - Country:US
Mailing Address - Phone:740-454-3106
Mailing Address - Fax:
Practice Address - Street 1:1810 ADAMS LN
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2612
Practice Address - Country:US
Practice Address - Phone:740-454-3106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH054216164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse