Provider Demographics
NPI:1417786492
Name:BOARDMAN, RENNE K
Entity type:Individual
Prefix:
First Name:RENNE
Middle Name:K
Last Name:BOARDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17325 ZIG ZAG DR
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-9342
Mailing Address - Country:US
Mailing Address - Phone:614-374-5004
Mailing Address - Fax:
Practice Address - Street 1:17325 ZIG ZAG DR
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-9342
Practice Address - Country:US
Practice Address - Phone:614-374-5004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker