Provider Demographics
NPI:1881669455
Name:ELMER, RENEE (CNP)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:ELMER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5410 MARYLAND WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5064
Mailing Address - Country:US
Mailing Address - Phone:615-377-5672
Mailing Address - Fax:888-241-1404
Practice Address - Street 1:801 13TH AVE
Practice Address - Street 2:
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282-1804
Practice Address - Country:US
Practice Address - Phone:309-792-6588
Practice Address - Fax:309-792-6562
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209002360363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00410598OtherRAILROAD MEDICARE
IL$$$$$$$$$001Medicaid
P00410598OtherRAILROAD MEDICARE
ILIL1240001Medicare PIN
Q60941Medicare UPIN