Provider Demographics
NPI:1518649987
Name:MCDONOUGH, RENEE MICHELE (RN)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:MICHELE
Last Name:MCDONOUGH
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 1:15759 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-1523
Mailing Address - Country:US
Mailing Address - Phone:917-864-8818
Mailing Address - Fax:
Practice Address - Street 1:1058 MORRIS PARK AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1478
Practice Address - Country:US
Practice Address - Phone:347-727-4222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY355187163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse