Basic Information
| Provider Information | |||||||||
| NPI: | 1154637528 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REYNOLDS | ||||||||
| FirstName: | JUDY | ||||||||
| MiddleName: | LORRAINE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3700 FETTLER PARK | ||||||||
| Address2: | DUMFRIES HEALTH CENTER | ||||||||
| City: | DUMFRIES | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034417500 | ||||||||
| FaxNumber: | 5403740378 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 FETTLER PARK | ||||||||
| Address2: | DUMFRIES HEALTH CENTER | ||||||||
| City: | DUMFRIES | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034417500 | ||||||||
| FaxNumber: | 5403741164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2010 | ||||||||
| LastUpdateDate: | 04/30/2013 | ||||||||
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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 | 363LF0000X | 0024168944 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.