Healthcare Provider Details

I. General information

NPI: 1689183287
Provider Name (Legal Business Name): RENEE JENNIFER HERRMANN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25631 LITTLE MACK AVE STE 203
SAINT CLAIR SHORES MI
48081-2108
US

IV. Provider business mailing address

26901 BEAUMONT BLVD STE 3D
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 586-443-2360
  • Fax:
Mailing address:
  • Phone: 947-522-4352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704266711
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: