Healthcare Provider Details

I. General information

NPI: 1639088412
Provider Name (Legal Business Name): RENEE CARRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 LAKEWOOD CT APT 17
MORICHES NY
11955-2007
US

IV. Provider business mailing address

66 LAKEWOOD CT APT 17
MORICHES NY
11955-2007
US

V. Phone/Fax

Practice location:
  • Phone: 631-522-2210
  • Fax:
Mailing address:
  • Phone: 631-522-2210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number650763
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: