Provider Demographics
NPI:1669936787
Name:ZACHARIAS, RENEE JEAN (APRNCNP)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:JEAN
Last Name:ZACHARIAS
Suffix:
Gender:F
Credentials:APRNCNP
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:JEAN
Other - Last Name:BOHANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6193 JAYCOX RD
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-1605
Mailing Address - Country:US
Mailing Address - Phone:440-714-7439
Mailing Address - Fax:
Practice Address - Street 1:29000 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5219
Practice Address - Country:US
Practice Address - Phone:440-835-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024116363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily