Individual
TRICIA RAE REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
63 W WILLOWBROOK DR, MERIDIAN, ID 83646-1656
(208) 888-7877
Mailing address
2416 E DEER POINT CT, EAGLE, ID 83616-3973
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP-1469A
ID
Other
Enumeration date
08/27/2014
Last updated
08/27/2014
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