MEDICARE: MS. RENEE SANNES PUZA RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	78039-030	WI
2	163WH0200X	Home Health Registered Nurse	78039-030	WI

General Provider Information

NPI Number	:	1013975747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RENEE SANNES PUZA RN

Provider Business Mailing Address
First Line	:	S106W30868 SANDY BEACH RD
Second Line	:
City	:	MUKWONAGO
State	:	WI
Zip	:	53149-9122
Country	:	US
Telephone Number	:	262-227-6323
Fax Number	:

Provider Business Practice Location Address
First Line	:	S106W30868 SANDY BEACH RD
Second Line	:
City	:	MUKWONAGO
State	:	WI
Zip	:	53149-9122
Country	:	US
Telephone Number	:	262-227-6323
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	05/13/2008

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