Provider Demographics
NPI:1093058836
Name:HAMPTON, RENEE E (LVN)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:E
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1754
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-1439
Mailing Address - Country:US
Mailing Address - Phone:909-327-6408
Mailing Address - Fax:909-245-1742
Practice Address - Street 1:12193 CUSTER ST
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-4485
Practice Address - Country:US
Practice Address - Phone:909-327-6408
Practice Address - Fax:909-245-1742
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA272406164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse