Provider Demographics
NPI:1295125276
Name:PRATT, RENEE
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:
Last Name:PRATT
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 1:1319 BLUESTONE AVE
Mailing Address - Street 2:#2
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-3701
Mailing Address - Country:US
Mailing Address - Phone:330-858-1149
Mailing Address - Fax:
Practice Address - Street 1:1319 BLUESTONE AVE
Practice Address - Street 2:#2
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-3701
Practice Address - Country:US
Practice Address - Phone:330-858-1149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2991740Medicaid