Provider Demographics
NPI:1538570924
Name:CICERO, RENEA ELIZABETH (CPM)
Entity type:Individual
Prefix:
First Name:RENEA
Middle Name:ELIZABETH
Last Name:CICERO
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6016 OLD PHILLIPS RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-2621
Mailing Address - Country:US
Mailing Address - Phone:757-377-0622
Mailing Address - Fax:
Practice Address - Street 1:6016 OLD PHILLIPS RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2621
Practice Address - Country:US
Practice Address - Phone:757-377-0622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0129000098176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife