Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 99274 | TX |
NPI | 1033668199 |
---|---|
Provider Name | Emily Reynolds |
First Address | Port Charlotte, FL 33948-2245 |
Second Address | Port Charlotte, FL 33948-2245 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2016 |
Last Update Date | 29/09/2016 |