Healthcare Provider Details

I. General information

NPI: 1104362185
Provider Name (Legal Business Name): RENEE HARRISON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 CHERRY ST
TOLEDO OH
43608-2603
US

IV. Provider business mailing address

2213 CHERRY ST
TOLEDO OH
43608-2603
US

V. Phone/Fax

Practice location:
  • Phone: 419-251-3232
  • Fax:
Mailing address:
  • Phone: 419-251-3232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRNCRNA019378
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704226538
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: