Healthcare Provider Details

I. General information

NPI: 1013975747
Provider Name (Legal Business Name): RENEE SANNES PUZA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S106W30868 SANDY BEACH RD
MUKWONAGO WI
53149-9122
US

IV. Provider business mailing address

S106W30868 SANDY BEACH RD
MUKWONAGO WI
53149-9122
US

V. Phone/Fax

Practice location:
  • Phone: 262-227-6323
  • Fax:
Mailing address:
  • Phone: 262-227-6323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number78039-030
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number78039-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: