Provider Demographics
NPI:1740226620
Name:SPEIR, RENEE STECKLEY (RPA-C)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:STECKLEY
Last Name:SPEIR
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:ELIZABETH
Other - Last Name:STECKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1202 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7307
Mailing Address - Country:US
Mailing Address - Phone:910-341-1540
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:8108 MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9386
Practice Address - Country:US
Practice Address - Phone:910-341-1540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0050030655363AM0700X
NC001013604363A00000X
NY010597363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02690944Medicaid
NYQ51408Medicare UPIN
NYJ400162365Medicare PIN
VTQ51408Medicare UPIN
NYPA1000Medicare ID - Type Unspecified