Provider Demographics
NPI:1205474046
Name:RENE, CHEMANE
Entity type:Individual
Prefix:
First Name:CHEMANE
Middle Name:
Last Name:RENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHEMANE
Other - Middle Name:RENE
Other - Last Name:FINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPG
Mailing Address - Street 1:PO BOX 40915
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89504-4915
Mailing Address - Country:US
Mailing Address - Phone:775-351-9023
Mailing Address - Fax:
Practice Address - Street 1:1455 CLOUGH RD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3113
Practice Address - Country:US
Practice Address - Phone:775-351-9023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20161067707174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator