Healthcare Provider Details

I. General information

NPI: 1356237341
Provider Name (Legal Business Name): RENEE FRANCES WAUTIER REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RENEE FRANCES WAUTIER REGISTERED NURSE

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5046 PLUM BOTTOM RD
EGG HARBOR WI
54209-9147
US

IV. Provider business mailing address

5046 PLUM BOTTOM RD
EGG HARBOR WI
54209-9147
US

V. Phone/Fax

Practice location:
  • Phone: 920-619-5242
  • Fax:
Mailing address:
  • Phone: 920-619-5242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number140279-030
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number140279-030
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number140279-030
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number140279-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: