Provider Demographics
NPI:1033351655
Name:RENDA, RENEE NICOLE (LPN)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:NICOLE
Last Name:RENDA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22705 LAKE SHORE BLVD
Mailing Address - Street 2:APT #230 B
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-1302
Mailing Address - Country:US
Mailing Address - Phone:216-240-9312
Mailing Address - Fax:
Practice Address - Street 1:22705 LAKE SHORE BLVD
Practice Address - Street 2:APT #230 B
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-1302
Practice Address - Country:US
Practice Address - Phone:216-240-9312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN111-755164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse