Provider Demographics
NPI:1306098348
Name:PARISI, RENEE DIANE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:DIANE
Last Name:PARISI
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:DIANE
Other - Last Name:PENNINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:4040 ERIE ST
Mailing Address - Street 2:PO BOX 665
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-7872
Mailing Address - Country:US
Mailing Address - Phone:856-949-3551
Mailing Address - Fax:
Practice Address - Street 1:4040 ERIE ST
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-7872
Practice Address - Country:US
Practice Address - Phone:856-949-3551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-10349363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN. 316598-COA1OtherREGISTERED NURSE
OHRX. 10349-EX1OtherCERTIFICATE TO PRESCRIBE-EXTERNSHIP
OHCOA. 10349-NPOtherCERTIFICATE OF AUTHORITY