Provider Demographics
NPI:1437605763
Name:SHORTER, RENEE V
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:V
Last Name:SHORTER
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 1:275 FERRY AVENUE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-3215
Mailing Address - Country:US
Mailing Address - Phone:248-862-4823
Mailing Address - Fax:248-732-7238
Practice Address - Street 1:275 FERRY AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-3215
Practice Address - Country:US
Practice Address - Phone:248-862-4823
Practice Address - Fax:248-732-7238
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other