Provider Demographics
NPI:1841939071
Name:RENNER, TAMMY S (RN)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:S
Last Name:RENNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9710 E 520 S
Mailing Address - Street 2:
Mailing Address - City:WOLCOTTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46795-9746
Mailing Address - Country:US
Mailing Address - Phone:260-402-6229
Mailing Address - Fax:
Practice Address - Street 1:2121 LAKE AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5100
Practice Address - Country:US
Practice Address - Phone:260-460-1345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-04
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28168212A163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine