Healthcare Provider Details

I. General information

NPI: 1326287590
Provider Name (Legal Business Name): RENEE LYNN MEKVOLD LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 HILLCREST PLAZA WAY
MONTROSE CO
81401-5876
US

IV. Provider business mailing address

64212 S RAMONA DR
MONTROSE CO
81403-4770
US

V. Phone/Fax

Practice location:
  • Phone: 970-252-0602
  • Fax:
Mailing address:
  • Phone: 970-901-8576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number805
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: