Provider Demographics
NPI:1639805864
Name:RENE, CLAIRE DESLENSON (SA-C)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:DESLENSON
Last Name:RENE
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:DESLENSON
Other - Last Name:RENE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SAC
Mailing Address - Street 1:4514 KINLOCK LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921-1448
Mailing Address - Country:US
Mailing Address - Phone:865-409-7780
Mailing Address - Fax:
Practice Address - Street 1:4514 KINLOCK LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-1448
Practice Address - Country:US
Practice Address - Phone:865-409-7780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
22-425246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty