Healthcare Provider Details

I. General information

NPI: 1255344503
Provider Name (Legal Business Name): RENEE M WISBY CMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 PATTERSON ST
NASHVILLE TN
37203-2926
US

IV. Provider business mailing address

1718 PATTERSON ST
NASHVILLE TN
37203-2926
US

V. Phone/Fax

Practice location:
  • Phone: 615-327-1085
  • Fax: 615-963-4733
Mailing address:
  • Phone: 615-327-1085
  • Fax: 615-963-4733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW588
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: