Provider Demographics
NPI:1043809940
Name:REYNOLDS, JULIE ANNE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 ASPEN HEIGHTS LN APT 632
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-4056
Mailing Address - Country:US
Mailing Address - Phone:706-604-8660
Mailing Address - Fax:
Practice Address - Street 1:721 ASPEN HEIGHTS LN APT 632
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-4056
Practice Address - Country:US
Practice Address - Phone:706-604-8660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program