Provider Demographics
NPI:1760703037
Name:WORTZ, RENAE G (NP)
Entity Type:Individual
Prefix:
First Name:RENAE
Middle Name:G
Last Name:WORTZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RENAE
Other - Middle Name:G
Other - Last Name:CHERNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:444 REGENCY PARKWAY DR STE 104
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3779
Mailing Address - Country:US
Mailing Address - Phone:402-932-2296
Mailing Address - Fax:
Practice Address - Street 1:444 REGENCY PARKWAY DR STE 104
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3779
Practice Address - Country:US
Practice Address - Phone:402-932-2296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704246800363LF0000X
NE111956363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily