Individual
PETAGAYE LATOYA REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
320 176TH ST E, SPANAWAY, WA 98387-8322
(253) 683-7400
(253) 683-7498
Mailing address
1441 GRINDSTONE DR SE, OLYMPIA, WA 98513-9446
(707) 724-9578
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
60869053
WA
Other
Enumeration date
03/21/2019
Last updated
03/21/2019
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