Provider Demographics
NPI:1578649372
Name:MANWORREN, RENEE CB (PHD, APRN, PCNS-BC)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:CB
Last Name:MANWORREN
Suffix:
Gender:F
Credentials:PHD, APRN, PCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4116 BLACKPOOL DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3127
Mailing Address - Country:US
Mailing Address - Phone:972-758-0751
Mailing Address - Fax:
Practice Address - Street 1:225 E. CHICAGO AVENUE, BOX 47
Practice Address - Street 2:ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-0084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX617183364SP0200X
CT4632364SP0200X
IL209014335364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics