Provider Demographics
NPI:1730135872
Name:CARROLL, RENEE LOMAN (RN, NP)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:LOMAN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 ACORN TRL
Mailing Address - Street 2:
Mailing Address - City:HORTON
Mailing Address - State:MI
Mailing Address - Zip Code:49246-9757
Mailing Address - Country:US
Mailing Address - Phone:517-688-4984
Mailing Address - Fax:
Practice Address - Street 1:551 ACORN TRL
Practice Address - Street 2:
Practice Address - City:HORTON
Practice Address - State:MI
Practice Address - Zip Code:49246-9757
Practice Address - Country:US
Practice Address - Phone:517-688-4984
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704088134363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health