Provider Demographics
NPI:1760967194
Name:HUTSELL, RENEE HOWELL (RN)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:HOWELL
Last Name:HUTSELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:LYNNE
Other - Last Name:HOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1711 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68826-1807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1711 15TH AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:NE
Practice Address - Zip Code:68826-1807
Practice Address - Country:US
Practice Address - Phone:308-946-3057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE71384163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-6004254OtherSCHOOL IDENTIFICATION NUMBER