Provider Demographics
NPI:1679520811
Name:NEFF, RENEE J (APRN)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:J
Last Name:NEFF
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8476
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8476
Mailing Address - Country:US
Mailing Address - Phone:801-542-8222
Mailing Address - Fax:801-542-8227
Practice Address - Street 1:1126 E 12300 S
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9095
Practice Address - Country:US
Practice Address - Phone:801-545-0600
Practice Address - Fax:801-545-0626
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT192897-4405363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP34946Medicare UPIN
UT005749006Medicare PIN