Provider Demographics
NPI:1457339848
Name:ANDERSON, RENEE (CRNA)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 16TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-5154
Mailing Address - Country:US
Mailing Address - Phone:970-350-6399
Mailing Address - Fax:970-378-4687
Practice Address - Street 1:1801 16TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631
Practice Address - Country:US
Practice Address - Phone:970-350-6399
Practice Address - Fax:970-378-4687
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCRA-644367500000X
NMR46512367500000X
COAPN.0000644-CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMPROVP11218OtherMOLINA
CO07530207Medicaid
NME0548Medicaid
NM10001388OtherLOVELACE HEALTH/SALUD
AZ897837OtherAHCCCS
NM201033429OtherPRESBYTERIAN HEALTH/SALUD
NMNM009S64OtherBC/BS
NME0548Medicaid
344503401Medicare ID - Type Unspecified