MEDICARE: RENE MICHELLE PHILLIPPE APRN, FNP-C,PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	28170462A	IN
2	363LF0000X	Family Nurse Practitioner	28170462A	IN

General Provider Information

NPI Number	:	1821578931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENE MICHELLE PHILLIPPE APRN, FNP-C,PMHNP-BC

Provider Business Mailing Address
First Line	:	7230 ENGLE RD STE 102
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-2234
Country	:	US
Telephone Number	:	260-820-0605
Fax Number	:

Provider Business Practice Location Address
First Line	:	7230 ENGLE RD STE 102
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-2234
Country	:	US
Telephone Number	:	260-820-0605
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2018
Last Update Date	:	09/18/2024

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