Provider Demographics
NPI:1952893372
Name:STOCKNER, RENITA
Entity Type:Individual
Prefix:
First Name:RENITA
Middle Name:
Last Name:STOCKNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2285 RENAISSANCE DR STE A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6753
Mailing Address - Country:US
Mailing Address - Phone:702-665-4717
Mailing Address - Fax:
Practice Address - Street 1:2285 RENAISSANCE DR STE A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6753
Practice Address - Country:US
Practice Address - Phone:702-665-4717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health