Provider Demographics
NPI:1104296227
Name:ADAMO, RENEE
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:ADAMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59131 BRANDYWINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48048-2020
Mailing Address - Country:US
Mailing Address - Phone:586-808-2633
Mailing Address - Fax:
Practice Address - Street 1:59131 BRANDYWINE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:MI
Practice Address - Zip Code:48048-2020
Practice Address - Country:US
Practice Address - Phone:586-808-2633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704298808163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse