Provider Demographics
NPI:1295003317
Name:FENDERSON, RENEE MICHELLE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:MICHELLE
Last Name:FENDERSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3134 JAKE PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-5002
Mailing Address - Country:US
Mailing Address - Phone:614-743-7993
Mailing Address - Fax:
Practice Address - Street 1:3134 JAKE PL
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-5002
Practice Address - Country:US
Practice Address - Phone:614-743-7993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-03
Last Update Date:2011-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH167W00000X164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse