Individual
HEATHER REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5177 MCCARTY LN, LAFAYETTE, IN 47905-8764
(765) 448-8000
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
71004931A
IN
363LG0600X
Gerontology Nurse Practitioner
71004931A
IN
363LX0106X
Occupational Health Nurse Practitioner
71004931A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201337320
—
IN
Enumeration date
06/10/2014
Last updated
02/19/2021
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