Healthcare Provider Details

I. General information

NPI: 1821173667
Provider Name (Legal Business Name): RENEE VERNELL REDDEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RENEE V REDDEN APRN,BC

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY AND WOODLAND AVES
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

5436 N FAIRHILL ST
PHILADELPHIA PA
19120-2711
US

V. Phone/Fax

Practice location:
  • Phone: 215-823-5800
  • Fax:
Mailing address:
  • Phone: 215-457-3076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN503490L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: