1275134926 NPI number — RENEE SOLANGE KING APRN

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 1275134926 NPI number — RENEE SOLANGE KING APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KING
Provider First Name:
RENEE
Provider Middle Name:
SOLANGE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GLENNON
Provider Other First Name:
RENEE
Provider Other Middle Name:
SOLANGE
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:
1275134926
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 BRIDGE ST STE 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03301-4922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-415-0090
Provider Business Mailing Address Fax Number:
833-944-2250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29 ASHLEIGH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DERRY
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03038-3054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-216-0277
Provider Business Practice Location Address Fax Number:
603-216-0272
Provider Enumeration Date:
11/07/2020

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:  036480-23 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 036480-23 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3125244 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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