Provider Demographics
NPI:1396787669
Name:L'ECUYER, RENEE I (APRN-BC)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:I
Last Name:L'ECUYER
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 GERVAIS ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-1805
Mailing Address - Country:US
Mailing Address - Phone:803-748-1181
Mailing Address - Fax:803-748-1185
Practice Address - Street 1:2117 GERVAIS ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-1805
Practice Address - Country:US
Practice Address - Phone:803-748-1181
Practice Address - Fax:803-748-1185
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF1243363LF0000X
SC1243207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0479Medicaid
SCP29404Medicare UPIN
SCNP0479Medicaid
SCP294049326Medicare PIN