Provider Demographics
NPI:1336935303
Name:RENAISSANCE HEALTH CENTER PLLC
Entity type:Organization
Organization Name:RENAISSANCE HEALTH CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHALON
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBBITT
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:919-730-5500
Mailing Address - Street 1:1738 HILLANDALE RD STE 102H
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3097
Mailing Address - Country:US
Mailing Address - Phone:919-730-5500
Mailing Address - Fax:
Practice Address - Street 1:1738 HILLANDALE RD STE 102H
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3097
Practice Address - Country:US
Practice Address - Phone:919-730-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty