Individual
GRACIE J REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
680 W CAMP SANGAMO RD, SPRINGFIELD, IL 62707-8422
(217) 494-8751
Mailing address
680 W CAMP SANGAMO RD, SPRINGFIELD, IL 62707-8422
(217) 494-8751
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209026250
IL
Other
Enumeration date
10/25/2022
Last updated
10/25/2022
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