Individual
SHELLY ANN REYNOLDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
28000 WOODWARD AVE STE 100, ROYAL OAK, MI 48067-0961
(248) 395-3777
Mailing address
28000 WOODWARD AVE STE 100, ROYAL OAK, MI 48067-0961
(248) 395-3777
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703051569
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4703051569
—
MI
Enumeration date
04/06/2020
Last updated
04/06/2020
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