Provider Demographics
NPI:1316263882
Name:DENOBREGA, RENEE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:
Last Name:DENOBREGA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-2110
Mailing Address - Country:US
Mailing Address - Phone:484-258-4513
Mailing Address - Fax:800-775-9427
Practice Address - Street 1:12 JEROME ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-2217
Practice Address - Country:US
Practice Address - Phone:484-258-4513
Practice Address - Fax:800-775-9427
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY596274163WP0808X
NY338327363LF0000X
PARN591223163W00000X
PASP018544363LP0808X
NY402334363LP0808X
PASP014029363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse