Provider Demographics
NPI:1417031378
Name:SCHWERTFEGER, RENEE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:SCHWERTFEGER
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:PO BOX 782
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-0782
Mailing Address - Country:US
Mailing Address - Phone:304-598-4861
Mailing Address - Fax:
Practice Address - Street 1:1 STADIUM DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506
Practice Address - Country:US
Practice Address - Phone:304-598-4861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201725207L00000X
WV57566363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00408275OtherRAILROAD MEDICARE
WV3810007766Medicaid
NC2808491Medicare ID - Type Unspecified
WVSC6035651Medicare PIN
P88908Medicare ID - Type Unspecified