Provider Demographics
NPI:1568132470
Name:OLTMANN, RENEE ELIZABETH
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:ELIZABETH
Last Name:OLTMANN
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 1:3501 DAUTERIVE DR
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-2405
Mailing Address - Country:US
Mailing Address - Phone:504-493-5401
Mailing Address - Fax:985-646-1005
Practice Address - Street 1:2053 GAUSE BLVD E
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5449
Practice Address - Country:US
Practice Address - Phone:985-646-1005
Practice Address - Fax:985-646-1001
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA011252790OtherDRIVER ;ICENSE
LALA011252790OtherDRIVER LICENSE NUMBER
LA011252790OtherDRIVER LICENSE
LA011252790Medicaid