Provider Demographics
NPI:1528699576
Name:MCDOUGAL, RENEE BROOKE
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:BROOKE
Last Name:MCDOUGAL
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 1:8888 KEYSTONE XING STE 1300
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-4600
Mailing Address - Country:US
Mailing Address - Phone:317-207-2808
Mailing Address - Fax:
Practice Address - Street 1:2159 GLEBE ST STE 270
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7372
Practice Address - Country:US
Practice Address - Phone:317-207-2808
Practice Address - Fax:855-293-2953
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2019072204363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily