Healthcare Provider Details

I. General information

NPI: 1720040140
Provider Name (Legal Business Name): RENEE ALTHOF RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34900 CHARDON RD STE 200
WILLOUGHBY HILLS OH
44094
US

IV. Provider business mailing address

34900 CHARDON RD STE 200
WILLOUGHBY HILLS OH
44094-9161
US

V. Phone/Fax

Practice location:
  • Phone: 440-951-5600
  • Fax: 440-951-1293
Mailing address:
  • Phone: 440-951-5600
  • Fax: 440-951-1293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN.133376
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number133376
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: