1669936787 NPI number — RENEE JEAN ZACHARIAS APRN.CNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669936787 NPI number — RENEE JEAN ZACHARIAS APRN.CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZACHARIAS
Provider First Name:
RENEE
Provider Middle Name:
JEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN.CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOHANNON
Provider Other First Name:
RENEE
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669936787
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6193 JAYCOX RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH RIDGEVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44039-1605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-714-7439
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29000 CENTER RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTLAKE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44145-5219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-835-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2019

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: 363LF0000X , with the licence number:  APRN.CNP.024116 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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