1265608251 NPI number — MRS. RENEE LYNNE DAVIS MSN RN CPNP

Table of content: MRS. RENEE LYNNE DAVIS MSN RN CPNP (NPI 1265608251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265608251 NPI number — MRS. RENEE LYNNE DAVIS MSN RN CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
RENEE
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN RN CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265608251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4600 MEMORIAL DRIVE
Provider Second Line Business Mailing Address:
SUITE G60
Provider Business Mailing Address City Name:
BELLEVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62226-5366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-257-2550
Provider Business Mailing Address Fax Number:
618-257-2569

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4600 MEMORIAL DRIVE
Provider Second Line Business Practice Location Address:
SUITE G60
Provider Business Practice Location Address City Name:
BELLEVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62226-5366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-257-2550
Provider Business Practice Location Address Fax Number:
618-257-2569
Provider Enumeration Date:
04/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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