Provider Demographics
NPI:1649677105
Name:STOTZ, RENEE (LPN)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:STOTZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2081 PERRY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH JAVA
Mailing Address - State:NY
Mailing Address - Zip Code:14113-9723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2081 PERRY RD
Practice Address - Street 2:
Practice Address - City:NORTH JAVA
Practice Address - State:NY
Practice Address - Zip Code:14113-9723
Practice Address - Country:US
Practice Address - Phone:585-322-3243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-28
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10-311107164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse