Healthcare Provider Details

I. General information

NPI: 1932185949
Provider Name (Legal Business Name): RENEE JEAN FITTERY LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 10/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMDT (CG-1122), U.S. COAST GUARD 2100 2ND ST SW, SUITE 5314
WASHINGTON DC
20593-0001
US

IV. Provider business mailing address

2950 NW 69TH AVE
MARGATE FL
33063-2044
US

V. Phone/Fax

Practice location:
  • Phone: 305-953-2266
  • Fax:
Mailing address:
  • Phone: 954-757-4054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: