Provider Demographics
NPI:1780114728
Name:SIMPSON, RENEE MARIE (CRNA)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:MARIE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:MARIE
Other - Last Name:THATCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 GARNER DR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-4428
Mailing Address - Country:US
Mailing Address - Phone:209-712-2731
Mailing Address - Fax:
Practice Address - Street 1:400 N PEPPER AVE
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1801
Practice Address - Country:US
Practice Address - Phone:909-580-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000724367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered