Provider Demographics
NPI:1467002345
Name:ALLEN, RENAE LOUISE (RN)
Entity Type:Individual
Prefix:
First Name:RENAE
Middle Name:LOUISE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 UTOPIA LN
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-5309
Mailing Address - Country:US
Mailing Address - Phone:808-280-5999
Mailing Address - Fax:
Practice Address - Street 1:1213 UTOPIA LN
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-5309
Practice Address - Country:US
Practice Address - Phone:808-280-5999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX958042163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse