Provider Demographics
NPI:1417711227
Name:RENNER, ALISHA (RN)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:RENNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ALISHA
Other - Middle Name:
Other - Last Name:CASSIDAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:303 ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:CLARE
Mailing Address - State:MI
Mailing Address - Zip Code:48617-9713
Mailing Address - Country:US
Mailing Address - Phone:989-544-0187
Mailing Address - Fax:
Practice Address - Street 1:303 ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:CLARE
Practice Address - State:MI
Practice Address - Zip Code:48617-9713
Practice Address - Country:US
Practice Address - Phone:989-544-0187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704360859REN24163W00000X, 163WC0400X
WARN60231762163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163W00000XNursing Service ProvidersRegistered Nurse