Provider Demographics
NPI:1760481386
Name:SALYER, RENEE K (PA-C)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:K
Last Name:SALYER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:K
Other - Last Name:CUENY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 EAST PARIS AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3680
Mailing Address - Country:US
Mailing Address - Phone:616-459-3158
Mailing Address - Fax:616-742-6758
Practice Address - Street 1:1000 EAST PARIS AVE SE STE 100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-459-3158
Practice Address - Fax:616-742-6758
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
MI5601004825363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1235188673OtherGROUP NPI FOR PCP
MIM94800P46Medicare PIN
MI1598712390OtherNPI GROUP
MIQ79177Medicare UPIN