Basic Information
| Provider Information | |||||||||
| NPI: | 1811055619 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REYNOLDS | ||||||||
| FirstName: | ROBYN | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 LAPEER | ||||||||
| Address2: | HEALTH DELIVERY INC | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486071208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897596464 | ||||||||
| FaxNumber: | 9893998233 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 LAPEER | ||||||||
| Address2: | HEALTH DELIVERY INC | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486071208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897596464 | ||||||||
| FaxNumber: | 9893998233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 02/14/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 5601004877 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 381908328-376 | 01 | MI | COMMUNITY CHOICE OF MICHIGAN/CXARE SOURCE | OTHER | 158607 | 01 | MI | GREALT LAKES HEALTH OF MICHIGAN | OTHER | 381908328-374 | 01 | MI | COMMUNITY CHOICE OF MICHIGAN/CARESOURCE | OTHER | 381908328-375 | 01 | MI | COMMUNITY CHOICE OF MICHIGAN/CARE SOURCE | OTHER | 468660 | 01 | MI | MOLINA HEALTHCARE | OTHER | 381908328-379 | 01 | MI | COMMUNITY CHOICE OF MICHIGAN/CARE SOURCE | OTHER | 381908328 | 01 | MI | TRICARE | OTHER | 381908328-380 | 01 | MI | COMMUNITY CHOICE OF MICHIGAN/CARE SOURE | OTHER | 381908328-377 | 01 | MI | COMMUNITY CHOICE OF MICHIGAN/CARE SOURCE | OTHER | 381908328-378 | 01 | MI | COMMUNITY CHOICE OF MICHIGAN/CARE SOURCE | OTHER | 381908328-381 | 01 | MI | COMMUNITY CHOICE OF MICHIGAN/CARE SOURCE | OTHER |