Provider Demographics
NPI:1134684475
Name:LONON, RENEE' ANGELIQUE
Entity Type:Individual
Prefix:
First Name:RENEE'
Middle Name:ANGELIQUE
Last Name:LONON
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 1:417 N COMANCHE ST APT 420
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-5655
Mailing Address - Country:US
Mailing Address - Phone:940-782-9137
Mailing Address - Fax:
Practice Address - Street 1:417 N COMANCHE ST APT 420
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-5655
Practice Address - Country:US
Practice Address - Phone:940-782-9137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1021962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102196OtherNATA