Provider Demographics
NPI:1568126464
Name:VANDEN AVOND, RENEE LYNN
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:LYNN
Last Name:VANDEN AVOND
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 1:525 ROBERT ST S
Mailing Address - Street 2:
Mailing Address - City:PIERZ
Mailing Address - State:MN
Mailing Address - Zip Code:56364-7158
Mailing Address - Country:US
Mailing Address - Phone:218-838-8408
Mailing Address - Fax:
Practice Address - Street 1:525 ROBERT ST S
Practice Address - Street 2:
Practice Address - City:PIERZ
Practice Address - State:MN
Practice Address - Zip Code:56364-7158
Practice Address - Country:US
Practice Address - Phone:218-838-8408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN256577374U00000X
MN1110841374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1110841OtherAFC LICENSE
MN1111492OtherBACKGROUND STUDY
MN256577OtherVENDOR NUMBER