Provider Demographics
NPI:1538160221
Name:REYNOLDS, HEATHER DAWN (CNM, MSN, FACNM)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:DAWN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:CNM, MSN, FACNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 SEA ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-2813
Mailing Address - Country:US
Mailing Address - Phone:203-777-3607
Mailing Address - Fax:203-785-6655
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:WOMEN'S CENTER TMPB
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06504-8900
Practice Address - Country:US
Practice Address - Phone:203-688-4101
Practice Address - Fax:203-688-7274
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000042367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004147452Medicaid