Healthcare Provider Details

I. General information

NPI: 1073603015
Provider Name (Legal Business Name): RENEE SANDRA STEWART RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENEE SANDRA SMYERS RD

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 CENTER ST KIDNEY TREATMENT CENTER OF PHILLIPSBURG - CKD SERVICES
PHILLIPSBURG NJ
08865-2663
US

IV. Provider business mailing address

RR 2 BOX 500TT
KUNKLETOWN PA
18058-9104
US

V. Phone/Fax

Practice location:
  • Phone: 908-454-7440
  • Fax: 908-454-9050
Mailing address:
  • Phone: 610-871-8212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number923321
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: