Provider Demographics
NPI:1851762645
Name:DUFAY, RENEE EVELINE (BSN)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:EVELINE
Last Name:DUFAY
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:EVELINE
Other - Last Name:KLINGBEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:307 MARQUETTE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-2830
Mailing Address - Country:US
Mailing Address - Phone:414-324-5585
Mailing Address - Fax:
Practice Address - Street 1:307 MARQUETTE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172-2830
Practice Address - Country:US
Practice Address - Phone:414-324-5585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI107664163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse