Healthcare Provider Details

I. General information

NPI: 1891894911
Provider Name (Legal Business Name): RENEE PLODZIK ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENEE DESCHENES

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 PLEASANT ST MEMORIAL BUILDING, WEST, FLOOR 2
CONCORD NH
03301-2548
US

IV. Provider business mailing address

246 PLEASANT ST MEMORIAL BUILDING, WEST, FLOOR 2
CONCORD NH
03301-2548
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-4003
  • Fax: 603-227-7562
Mailing address:
  • Phone: 603-224-4003
  • Fax: 603-227-7562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number049200-23-05
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: