Provider Demographics
NPI:1265742712
Name:WALDEN, RENEE ANTOINETTE
Entity type:Individual
Prefix:MS
First Name:RENEE
Middle Name:ANTOINETTE
Last Name:WALDEN
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 1:4100 N MARTIN L KING BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-0293
Mailing Address - Country:US
Mailing Address - Phone:702-522-7800
Mailing Address - Fax:702-974-1264
Practice Address - Street 1:4100 N MARTIN L KING BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-0293
Practice Address - Country:US
Practice Address - Phone:702-522-7800
Practice Address - Fax:702-974-1264
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker