Healthcare Provider Details

I. General information

NPI: 1003290883
Provider Name (Legal Business Name): RENEE M SCHNUPP PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2015
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7580 NORTHCLIFF AVE STE 1000
BROOKLYN OH
44144-3271
US

IV. Provider business mailing address

850 COLUMBIA RD STE 200
WESTLAKE OH
44145-7215
US

V. Phone/Fax

Practice location:
  • Phone: 440-808-1212
  • Fax:
Mailing address:
  • Phone: 440-808-1212
  • Fax: 440-808-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.004385
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: