Provider Demographics
NPI:1952499642
Name:FELLER, RENEE C (MS, APRN/PMH)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:C
Last Name:FELLER
Suffix:
Gender:F
Credentials:MS, APRN/PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8816 ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1112
Mailing Address - Country:US
Mailing Address - Phone:410-602-2124
Mailing Address - Fax:
Practice Address - Street 1:2 RESERVOIR CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-6393
Practice Address - Country:US
Practice Address - Phone:410-484-0809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRO90533364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403RMedicare ID - Type Unspecified