Provider Demographics
NPI:1144991381
Name:STORM, RENEE DENISE (APRN)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:DENISE
Last Name:STORM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 NW KEARNEY ST APT 921
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2770
Mailing Address - Country:US
Mailing Address - Phone:503-467-6589
Mailing Address - Fax:
Practice Address - Street 1:1309 NE 134TH ST STE B
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2704
Practice Address - Country:US
Practice Address - Phone:503-467-6589
Practice Address - Fax:571-368-5192
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61243325363LA2100X
OR202110572NP-PP363LA2100X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology