Provider Demographics
NPI:1295843266
Name:REMINGTON, RENEE K
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:K
Last Name:REMINGTON
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 1:2801 W KINNICKINNIC RIVER PKWY STE 460
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3695
Mailing Address - Country:US
Mailing Address - Phone:414-389-7388
Mailing Address - Fax:414-389-9069
Practice Address - Street 1:2801 W KINNICKINNIC RIVER PKWY STE 460
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3695
Practice Address - Country:US
Practice Address - Phone:414-389-7388
Practice Address - Fax:414-389-9069
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI111138363LA2100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43873500Medicaid
WI000202915Medicare ID - Type Unspecified
WI43873500Medicaid