Provider Demographics
NPI:1780748251
Name:STEIDER, RENEE PHYLLIS
Entity type:Individual
Prefix:MS
First Name:RENEE
Middle Name:PHYLLIS
Last Name:STEIDER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:RENEE
Other - Middle Name:PHYLLIS
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:314 M ST
Mailing Address - City:MC COOL JUNCTION
Mailing Address - State:NE
Mailing Address - Zip Code:68401
Mailing Address - Country:US
Mailing Address - Phone:402-366-8406
Mailing Address - Fax:
Practice Address - Street 1:831 F ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NE
Practice Address - Zip Code:68361
Practice Address - Country:US
Practice Address - Phone:402-759-4761
Practice Address - Fax:402-759-4761
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47052851589Medicaid
NE47052851594Medicaid