Provider Demographics
NPI:1790564250
Name:RENNER, JENEE L
Entity Type:Individual
Prefix:MRS
First Name:JENEE
Middle Name:L
Last Name:RENNER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JENEE
Other - Middle Name:L
Other - Last Name:RENNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTHER
Mailing Address - Street 1:3005 BLADENSBURG RD NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-2265
Mailing Address - Country:US
Mailing Address - Phone:202-999-6518
Mailing Address - Fax:
Practice Address - Street 1:3005 BLADENSBURG RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-2265
Practice Address - Country:US
Practice Address - Phone:202-999-6518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator