Provider Demographics
NPI:1023387032
Name:TRAVERSI, RENEE (BSN CPON)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:
Last Name:TRAVERSI
Suffix:
Gender:F
Credentials:BSN CPON
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 EUREKA RD
Mailing Address - Street 2:BLDG C - PEDI SPECIALTIES
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3027
Mailing Address - Country:US
Mailing Address - Phone:916-474-2335
Mailing Address - Fax:
Practice Address - Street 1:1600 EUREKA RD
Practice Address - Street 2:BLDG C - PEDI SPECIALTIES
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3027
Practice Address - Country:US
Practice Address - Phone:916-474-2335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA418032163W00000X, 163WP0200X, 163WP0218X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0218XNursing Service ProvidersRegistered NursePediatric Oncology
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0200XNursing Service ProvidersRegistered NursePediatrics