Provider Demographics
NPI:1184973471
Name:LIKONG, RENEE
Entity type:Individual
Prefix:MS
First Name:RENEE
Middle Name:
Last Name:LIKONG
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 1:266 ELMWOOD AVE
Mailing Address - Street 2:#169
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-2202
Mailing Address - Country:US
Mailing Address - Phone:443-525-7534
Mailing Address - Fax:
Practice Address - Street 1:266 ELMWOOD AVE
Practice Address - Street 2:#169
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-2202
Practice Address - Country:US
Practice Address - Phone:443-525-7534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-03
Last Update Date:2012-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283433-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse