Provider Demographics
NPI:1063814069
Name:ANDREE, RENEE JENNIFER (APRN)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:JENNIFER
Last Name:ANDREE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:TICCONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6100 ROCKSIDE WOODS BLVD N
Mailing Address - Street 2:STE 425
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2366
Mailing Address - Country:US
Mailing Address - Phone:216-643-2780
Mailing Address - Fax:216-524-0111
Practice Address - Street 1:6100 ROCKSIDE WOODS BLVD N
Practice Address - Street 2:STE 425
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2366
Practice Address - Country:US
Practice Address - Phone:216-643-2780
Practice Address - Fax:216-524-0111
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 16498- NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health