Provider Demographics
NPI:1699382648
Name:ANDERSON, RENEE
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:
Last Name:ANDERSON
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 1:361 NUMBER 8 PIKE
Mailing Address - Street 2:
Mailing Address - City:WELLSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45692-9406
Mailing Address - Country:US
Mailing Address - Phone:740-978-3501
Mailing Address - Fax:
Practice Address - Street 1:361 NUMBER 8 PIKE
Practice Address - Street 2:
Practice Address - City:WELLSTON
Practice Address - State:OH
Practice Address - Zip Code:45692-9406
Practice Address - Country:US
Practice Address - Phone:740-978-3501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health