Provider Demographics
NPI:1548679442
Name:CENTER, RENEE (RN, MSN, CNS, CEN)
Entity type:Individual
Prefix:MS
First Name:RENEE
Middle Name:
Last Name:CENTER
Suffix:
Gender:F
Credentials:RN, MSN, CNS, CEN
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:CENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MSN, CNS, CEN
Mailing Address - Street 1:216 PHELAN AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-6463
Mailing Address - Country:US
Mailing Address - Phone:707-319-3630
Mailing Address - Fax:
Practice Address - Street 1:216 PHELAN AVE
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-6463
Practice Address - Country:US
Practice Address - Phone:707-319-3630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA547410364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist