Provider Demographics
NPI:1720040140
Name:ALTHOF, RENEE (RN, CNS)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:ALTHOF
Suffix:
Gender:F
Credentials:RN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34900 CHARDON RD
Mailing Address - Street 2:STE 200
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9161
Mailing Address - Country:US
Mailing Address - Phone:440-951-5600
Mailing Address - Fax:440-951-1293
Practice Address - Street 1:34900 CHARDON RD STE 200
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44094
Practice Address - Country:US
Practice Address - Phone:440-951-5600
Practice Address - Fax:440-951-1293
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH133376163WP0807X
OHRN.133376364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2373408Medicaid
OHNSO1844Medicare ID - Type Unspecified
OH2373408Medicaid