Provider Demographics
NPI:1629132808
Name:RENNER, TUESDAY MICHELE (MD)
Entity Type:Individual
Prefix:DR
First Name:TUESDAY
Middle Name:MICHELE
Last Name:RENNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 NEW DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:NH
Mailing Address - Zip Code:03809-4917
Mailing Address - Country:US
Mailing Address - Phone:603-875-6151
Mailing Address - Fax:603-875-2944
Practice Address - Street 1:27 NEW DURHAM RD
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:NH
Practice Address - Zip Code:03809-4917
Practice Address - Country:US
Practice Address - Phone:603-875-6151
Practice Address - Fax:603-875-2944
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12853207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE8500Medicare ID - Type Unspecified
NHI44894Medicare UPIN