Provider Demographics
NPI:1093950255
Name:OBEDISCO, RENAE ELIZABETH (RN)
Entity Type:Individual
Prefix:
First Name:RENAE
Middle Name:ELIZABETH
Last Name:OBEDISCO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:RENAE
Other - Middle Name:ELIZABETH
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:3333 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-1228
Mailing Address - Country:US
Mailing Address - Phone:216-741-1392
Mailing Address - Fax:
Practice Address - Street 1:3333 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-1228
Practice Address - Country:US
Practice Address - Phone:216-741-1392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN244910163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care