1356749485 NPI number — MS. TRACI-ANN SEANA REYNOLDS RDH

Table of content: MS. TRACI-ANN SEANA REYNOLDS RDH (NPI 1356749485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356749485 NPI number — MS. TRACI-ANN SEANA REYNOLDS RDH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYNOLDS
Provider First Name:
TRACI-ANN
Provider Middle Name:
SEANA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RDH
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:
1356749485
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 225
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MASONVILLE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1135 N. LINCOLN AVE
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
LOVELAND
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-622-0970
Provider Business Practice Location Address Fax Number:
970-622-0971
Provider Enumeration Date:
12/05/2014

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: 124Q00000X , with the licence number:  DH000201948 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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