Provider Demographics
NPI:1194695999
Name:BROWN, RENEE SHALANTA BENNIE (RN)
Entity type:Individual
Prefix:MS
First Name:RENEE
Middle Name:SHALANTA BENNIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48554 MICHAYWE DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-2307
Mailing Address - Country:US
Mailing Address - Phone:586-626-6039
Mailing Address - Fax:
Practice Address - Street 1:4201 SAINT ANTOINE ST STE 5
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-996-0639
Practice Address - Fax:313-745-8165
Is Sole Proprietor?:No
Enumeration Date:2025-11-06
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704344333390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program