Provider Demographics
NPI:1821173667
Name:REDDEN, RENEE VERNELL (NP)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:VERNELL
Last Name:REDDEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:V
Other - Last Name:REDDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN,BC
Mailing Address - Street 1:5436 N FAIRHILL ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2711
Mailing Address - Country:US
Mailing Address - Phone:215-457-3076
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY AND WOODLAND AVES
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-823-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN503490L163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)