Provider Demographics
NPI:1740469360
Name:HALLIDAY, RENEE AUTUMN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:AUTUMN
Last Name:HALLIDAY
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:11800 CLARIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-8220
Mailing Address - Country:US
Mailing Address - Phone:517-881-0399
Mailing Address - Fax:
Practice Address - Street 1:1140 E MICHIGAN AVE STE 400
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1806
Practice Address - Country:US
Practice Address - Phone:517-364-9650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601005152363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical