Provider Demographics
NPI:1396449666
Name:CROOME, RENEE
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:CROOME
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 1:5927 FIRETHORNE LN
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-9115
Mailing Address - Country:US
Mailing Address - Phone:704-787-9393
Mailing Address - Fax:
Practice Address - Street 1:5927 FIRETHORNE LN
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-9115
Practice Address - Country:US
Practice Address - Phone:347-531-9115
Practice Address - Fax:704-787-9393
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCKAH-6534347C00000X
NCYHVH-AT347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle