Provider Demographics
NPI:1386785723
Name:RENOIR, CORINNE R (LVN)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:R
Last Name:RENOIR
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1471 B ST STE N
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:CA
Mailing Address - Zip Code:95334-1426
Mailing Address - Country:US
Mailing Address - Phone:209-394-4032
Mailing Address - Fax:209-394-4166
Practice Address - Street 1:1471 B ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:CA
Practice Address - Zip Code:95334-1432
Practice Address - Country:US
Practice Address - Phone:209-394-4032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN88841164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse