Provider Demographics
NPI:1437811395
Name:WIRUTH, RENEE (DNP)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:WIRUTH
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:STURNIOLO
Other - Last Name:WIRUTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 31235
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1235
Mailing Address - Country:US
Mailing Address - Phone:520-324-2684
Mailing Address - Fax:
Practice Address - Street 1:10350 E DREXEL RD UNIT 110
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-9409
Practice Address - Country:US
Practice Address - Phone:520-324-1727
Practice Address - Fax:520-324-1700
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ277425363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty