Provider Demographics
NPI:1558748277
Name:KATSINIS, RENEE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:KATSINIS
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 1:9725 PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-3616
Mailing Address - Country:US
Mailing Address - Phone:219-924-5300
Mailing Address - Fax:
Practice Address - Street 1:1946 45TH ST STE C
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3956
Practice Address - Country:US
Practice Address - Phone:219-440-5334
Practice Address - Fax:219-440-5335
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005426A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics