Provider Demographics
NPI:1992962880
Name:RENIER, NANCY ANN (RN)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ANN
Last Name:RENIER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7313 LONGMEADOW RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1066
Mailing Address - Country:US
Mailing Address - Phone:608-469-1011
Mailing Address - Fax:
Practice Address - Street 1:5550 CADDIS BND APT 102
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-7141
Practice Address - Country:US
Practice Address - Phone:608-270-1190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI68342-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38208100Medicaid