Provider Demographics
NPI:1205377603
Name:ALTMAN, RENEE (LAC)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:ALTMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4275 S 108TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-1907
Mailing Address - Country:US
Mailing Address - Phone:414-727-4640
Mailing Address - Fax:414-727-4636
Practice Address - Street 1:4275 S 108TH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-1907
Practice Address - Country:US
Practice Address - Phone:414-727-4640
Practice Address - Fax:414-727-4636
Is Sole Proprietor?:No
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI938-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist