Provider Demographics
NPI:1144733007
Name:REYNOLDS, SUSAN MARIE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 SHEFFIELD ST NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-5844
Mailing Address - Country:US
Mailing Address - Phone:330-205-1040
Mailing Address - Fax:
Practice Address - Street 1:2600 TUSCARAWAS ST W STE 440
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4698
Practice Address - Country:US
Practice Address - Phone:330-453-4000
Practice Address - Fax:330-456-2866
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021891207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine