Individual
DEREK JOHN REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
SAINT REGIS MOHAWK TRIBE HEALTH SERVICES, 404 STATE ROUTE 37, HOGANSBURG, NY 13655-3109
(518) 358-3141
(518) 358-9175
Mailing address
SAINT REGIS MOHAWK TRIBE HEALTH SERVICES, 404 STATE ROUTE 37, HOGANSBURG, NY 13655-3109
(518) 358-3141
(518) 358-9175
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F338090-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03619812
—
NY
Enumeration date
06/26/2013
Last updated
03/30/2023
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