Provider Demographics
NPI:1528392362
Name:CLYATT, RENEE A
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:A
Last Name:CLYATT
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 1:3620 ASPEN ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-1620
Mailing Address - Country:US
Mailing Address - Phone:267-593-1945
Mailing Address - Fax:
Practice Address - Street 1:3620 ASPEN ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19104-1620
Practice Address - Country:US
Practice Address - Phone:267-593-1945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-27
Last Update Date:2009-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN086771-L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse