Provider Demographics
NPI:1073207452
Name:PETTUS, RENEE SHUMAKER
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:SHUMAKER
Last Name:PETTUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7524 LANCER DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-7510
Mailing Address - Country:US
Mailing Address - Phone:704-502-1880
Mailing Address - Fax:
Practice Address - Street 1:317 RUTH VISTA RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-8628
Practice Address - Country:US
Practice Address - Phone:704-502-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist