Provider Demographics
NPI:1093561730
Name:CLAYBON, RENEE CHEREE (ARNP)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:CHEREE
Last Name:CLAYBON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 LILLY RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5133
Mailing Address - Country:US
Mailing Address - Phone:360-628-6332
Mailing Address - Fax:
Practice Address - Street 1:8202 WALTHEW CT SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-4165
Practice Address - Country:US
Practice Address - Phone:360-628-6332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60237697163W00000X
WAAP61652349363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse