Provider Demographics
NPI:1811364508
Name:EDGE, RENEE D (APNP)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:D
Last Name:EDGE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9177 OLD POTOSI RD
Mailing Address - Street 2:PO BOX 271
Mailing Address - City:LANCASTER
Mailing Address - State:WI
Mailing Address - Zip Code:53813-9437
Mailing Address - Country:US
Mailing Address - Phone:608-723-4300
Mailing Address - Fax:608-723-7885
Practice Address - Street 1:9177 OLD POTOSI RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:WI
Practice Address - Zip Code:53813-9437
Practice Address - Country:US
Practice Address - Phone:608-723-4300
Practice Address - Fax:608-723-7885
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6604363LF0000X
WI6604-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI6604OtherSTATE OF WISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES
WI2015010721OtherAMERICAN NURSES CREDENTIALLING CENTER