Provider Demographics
NPI:1619583549
Name:FARR, RENEE MICHELLE (LPN)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:MICHELLE
Last Name:FARR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:MICHELLE
Other - Last Name:SOLMES, GRILLOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3900 LOFTUS RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:MI
Mailing Address - Zip Code:49325-9452
Mailing Address - Country:US
Mailing Address - Phone:269-953-2359
Mailing Address - Fax:
Practice Address - Street 1:3900 LOFTUS RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:MI
Practice Address - Zip Code:49325-9452
Practice Address - Country:US
Practice Address - Phone:269-953-2359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703110704164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse