Provider Demographics
NPI:1154488310
Name:BRENNER, RENEE B
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:B
Last Name:BRENNER
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 1:6344 SHEPLER CHURCH AVE SW
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:OH
Mailing Address - Zip Code:44662-9741
Mailing Address - Country:US
Mailing Address - Phone:330-484-3650
Mailing Address - Fax:
Practice Address - Street 1:6344 SHEPLER CHURCH AVE SW
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:OH
Practice Address - Zip Code:44662-9741
Practice Address - Country:US
Practice Address - Phone:330-484-3650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2405721390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2405721OtherPROVIDER I.D. NUMBER