Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 9701856 | NC |
N | 2080P0203X | Pediatric Critical Care Doctor | 11712 | NV |
Y | 2080P0203X | Pediatric Critical Care Doctor | 4743 | SD |
N | 2080P0204X | Pediatric Emergency Doctor | 38372 | CO |
N | 2080P0214X | Pediatric Pulmonologist | 4743 | SD |
NPI | 1124076278 |
---|---|
Provider Name | Kathy L Reynolds |
First Address | Minneapolis, MN 55485-0090 |
Second Address | Sioux Falls, SD 57105-1016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 13/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002019725 | (05) | NV |
063407700 | (05) | MN |
64900789 | (05) | CO |
6700510 | (05) | SD |
891113P | (05) | NC |
E95777 | (02) |