Provider Demographics
NPI:1316213697
Name:QUILLET, RENEE SUZETTE
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:SUZETTE
Last Name:QUILLET
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 1:14225 COUNTY ROAD B
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-9442
Mailing Address - Country:US
Mailing Address - Phone:419-337-6347
Mailing Address - Fax:
Practice Address - Street 1:14225 COUNTY ROAD B
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-9442
Practice Address - Country:US
Practice Address - Phone:419-337-6347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2564774OtherPROVIDER NUMBER