Individual
SUSAN JEAN REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CPNP
Contact information
Practice address
9802 WOODBURY AVE, GARDEN GROVE, CA 92844-2819
(714) 663-6411
(714) 663-6470
Mailing address
20652 FARNSWORTH LN, HUNTINGTON BEACH, CA 92646-5522
(714) 536-0348
(714) 969-2647
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
230910
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1458726
PIN#
CA
01
—
SS3066522
PROVIDER NUMBER
CA
Enumeration date
03/01/2007
Last updated
07/08/2007
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