Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F304878 | NY |
NPI | 1023273232 |
---|---|
Provider Name | Tina Marie Reynolds |
First Address | Buffalo, NY 14263-0001 |
Second Address | Buffalo, NY 14210-1351 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2008 |
Last Update Date | 28/10/2019 |