Provider Demographics
NPI:1144982877
Name:TITLEY, RENEE M
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:M
Last Name:TITLEY
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 1:1626 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IL
Mailing Address - Zip Code:62060-1426
Mailing Address - Country:US
Mailing Address - Phone:503-660-2042
Mailing Address - Fax:
Practice Address - Street 1:1626 7TH ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IL
Practice Address - Zip Code:62060-1426
Practice Address - Country:US
Practice Address - Phone:503-660-2042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No175L00000XOther Service ProvidersHomeopath
No253Z00000XAgenciesIn Home Supportive Care
No372500000XNursing Service Related ProvidersChore Provider