Healthcare Provider Details

I. General information

NPI: 1114974177
Provider Name (Legal Business Name): DAVID A RENNE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 116TH AVE NE STE 330
BELLEVUE WA
98004-4621
US

IV. Provider business mailing address

5000 CHESHIRE PKWY N
PLYMOUTH MN
55446-4103
US

V. Phone/Fax

Practice location:
  • Phone: 425-455-5596
  • Fax: 425-451-3248
Mailing address:
  • Phone: 888-510-0766
  • Fax: 763-268-4430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberLD00001946
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: