Healthcare Provider Details

I. General information

NPI: 1295366755
Provider Name (Legal Business Name): RENEE C YUNKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U469 COUNTY ROAD 1D
LIBERTY CENTER OH
43532-9598
US

IV. Provider business mailing address

1905 PERRYSBURG HOLLAND RD
HOLLAND OH
43528-9582
US

V. Phone/Fax

Practice location:
  • Phone: 419-693-1520
  • Fax:
Mailing address:
  • Phone: 419-693-1520
  • Fax: 419-693-3295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: