Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 90072 | OK |
NPI | 1013280247 |
---|---|
Provider Name | Mrs. Melanie Reynolds |
First Address | Oklahoma City, OK 73104-5047 |
Second Address | Oklahoma City, OK 73104-5047 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2012 |
Last Update Date | 19/02/2012 |