Provider Demographics
NPI:1891974663
Name:HUGHES, RENEE ANNE (LPN)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:ANNE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:ANNE
Other - Last Name:RANDAZZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7798 US ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12932-2612
Mailing Address - Country:US
Mailing Address - Phone:518-873-2040
Mailing Address - Fax:
Practice Address - Street 1:2842 PLANK ROAD
Practice Address - Street 2:
Practice Address - City:MORIAH CT.
Practice Address - State:NY
Practice Address - Zip Code:12961
Practice Address - Country:US
Practice Address - Phone:518-873-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265490-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02822080Medicaid