Provider Demographics
NPI:1649642612
Name:DEFREITAS, RENAE N (CRNP)
Entity type:Individual
Prefix:
First Name:RENAE
Middle Name:N
Last Name:DEFREITAS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3614 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6983
Mailing Address - Country:US
Mailing Address - Phone:484-547-8060
Mailing Address - Fax:
Practice Address - Street 1:1005 BROOKSIDE RD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9023
Practice Address - Country:US
Practice Address - Phone:610-351-0419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-29
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025849363LP0808X
PASP015541363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health