Individual
LAEL JO REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2705 E 17TH ST, AMMON, ID 83406-6601
(208) 346-7522
Mailing address
158 S 2ND E, REXBURG, ID 83440-1909
(208) 206-0692
Taxonomy
Speciality
Code
Description
License number
State
163WP1700X
Perinatal Registered Nurse
Primary
N-30935
ID
Other
Enumeration date
12/06/2021
Last updated
12/29/2021
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