Healthcare Provider Details

I. General information

NPI: 1255442919
Provider Name (Legal Business Name): CAROLYN RENEE DENNEHEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLYN RENEE FLUGSTAD

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E 2ND ST STE 300
RENO NV
89502-1198
US

IV. Provider business mailing address

850 HARVARD WAY
RENO NV
89502-2055
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-2808
  • Fax: 775-982-2818
Mailing address:
  • Phone: 775-982-4590
  • Fax: 775-982-5496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number15750
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: