Individual
ALLYSON R REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
100 E IDAHO ST, STE 300, BOISE, ID 83712-6267
(208) 381-7370
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-7370
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
N36247
ID
363L00000X
Nurse Practitioner
Primary
NP978A
ID
Other
Enumeration date
05/13/2010
Last updated
08/19/2012
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