1093953358 NPI number — LEANN MICHELLE MCREYNOLDS MSN, RN, CCNS-BC

Table of content: LEANN MICHELLE MCREYNOLDS MSN, RN, CCNS-BC (NPI 1093953358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093953358 NPI number — LEANN MICHELLE MCREYNOLDS MSN, RN, CCNS-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCREYNOLDS
Provider First Name:
LEANN
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, RN, CCNS-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093953358
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 264
Provider Second Line Business Mailing Address:
210 W MEYER
Provider Business Mailing Address City Name:
FALLS CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78113-0264
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-254-9616
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4410 MEDICAL DR
Provider Second Line Business Practice Location Address:
SUITE 440
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-6306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-692-9400
Provider Business Practice Location Address Fax Number:
210-692-0971
Provider Enumeration Date:
01/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SC0200X , with the licence number:  670554 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com