Provider Demographics
NPI:1003290883
Name:SCHNUPP, RENEE M (PA-C)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:M
Last Name:SCHNUPP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 COLUMBIA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-7215
Mailing Address - Country:US
Mailing Address - Phone:440-808-1212
Mailing Address - Fax:440-808-2060
Practice Address - Street 1:7580 NORTHCLIFF AVE STE 1000
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:OH
Practice Address - Zip Code:44144-3271
Practice Address - Country:US
Practice Address - Phone:440-808-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-12
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004385363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP01971447OtherMEDIARE RAILROAD
OH0149565Medicaid