Provider Demographics
NPI:1669017794
Name:BEMILLER, RENAY ANN
Entity Type:Individual
Prefix:MS
First Name:RENAY
Middle Name:ANN
Last Name:BEMILLER
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 1:102 WESTGATE BLVD
Mailing Address - Street 2:
Mailing Address - City:WAKARUSA
Mailing Address - State:IN
Mailing Address - Zip Code:46573-8507
Mailing Address - Country:US
Mailing Address - Phone:574-612-3757
Mailing Address - Fax:
Practice Address - Street 1:102 WESTGATE BLVD
Practice Address - Street 2:
Practice Address - City:WAKARUSA
Practice Address - State:IN
Practice Address - Zip Code:46573-8507
Practice Address - Country:US
Practice Address - Phone:574-612-3757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN8942-92-6102347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker