Provider Demographics
NPI:1053031328
Name:REYNOLDS, DANA LEANN
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:LEANN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 HIGH ST APT 0
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-5563
Mailing Address - Country:US
Mailing Address - Phone:681-285-2754
Mailing Address - Fax:
Practice Address - Street 1:381 HIGH ST APT 0
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-5563
Practice Address - Country:US
Practice Address - Phone:681-285-2754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant