Healthcare Provider Details

I. General information

NPI: 1205275237
Provider Name (Legal Business Name): MONICA RENO CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W TERRELL AVE STE 320
FORT WORTH TX
76104-2822
US

IV. Provider business mailing address

1300 W TERRELL AVE STE 320
FORT WORTH TX
76104-2822
US

V. Phone/Fax

Practice location:
  • Phone: 817-250-7360
  • Fax:
Mailing address:
  • Phone: 817-250-7360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number9346003-4402
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP126708
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: