Provider Demographics
NPI:1184942229
Name:PAUL, RENEE MICHELLE
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:MICHELLE
Last Name:PAUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10877 CONDUCTOR BLVD
Mailing Address - Street 2:SU. # 300
Mailing Address - City:SUTTER CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95685-9682
Mailing Address - Country:US
Mailing Address - Phone:209-223-6412
Mailing Address - Fax:209-223-0920
Practice Address - Street 1:10877 CONDUCTOR BLVD
Practice Address - Street 2:STE 300
Practice Address - City:SUTTER CREEK
Practice Address - State:CA
Practice Address - Zip Code:95685-9682
Practice Address - Country:US
Practice Address - Phone:209-223-6412
Practice Address - Fax:209-223-0920
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN726989163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse