Provider Demographics
NPI:1356119390
Name:REYNOLDS, STEPHANIE (CD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 E SCHOOL WAY
Mailing Address - Street 2:
Mailing Address - City:REDWOOD VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95470-6319
Mailing Address - Country:US
Mailing Address - Phone:707-972-8933
Mailing Address - Fax:
Practice Address - Street 1:791 E SCHOOL WAY
Practice Address - Street 2:
Practice Address - City:REDWOOD VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95470-6319
Practice Address - Country:US
Practice Address - Phone:707-972-8933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education