Provider Demographics
NPI:1356237341
Name:WAUTIER, RENEE FRANCES (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:FRANCES
Last Name:WAUTIER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MS
Other - First Name:RENEE
Other - Middle Name:FRANCES
Other - Last Name:WAUTIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:5046 PLUM BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR
Mailing Address - State:WI
Mailing Address - Zip Code:54209-9147
Mailing Address - Country:US
Mailing Address - Phone:920-619-5242
Mailing Address - Fax:
Practice Address - Street 1:5046 PLUM BOTTOM RD
Practice Address - Street 2:
Practice Address - City:EGG HARBOR
Practice Address - State:WI
Practice Address - Zip Code:54209-9147
Practice Address - Country:US
Practice Address - Phone:920-619-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI140279-030163W00000X, 163WG0000X, 251J00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health Worker
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No251J00000XAgenciesNursing Care