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NPI Code Detail

MEDICARE: RENEE FANNING

MEDICARE: RENEE FANNING
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1215578307
Entity Type Code : Individual
Provider Name (Legal Business Name) : RENEE FANNING
Provider Business Mailing Address
First Line : 1500 S DOUGLAS RD STE 230
Second Line :
City : CORAL GABLES
State : FL
Zip : 33134-4108
Country : US
Telephone Number : 844-854-1116
Fax Number :
Provider Business Practice Location Address
First Line : 19540 AMARANTH DR
Second Line :
City : GERMANTOWN
State : MD
Zip : 20874-1202
Country : US
Telephone Number : 844-854-1116
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2019
Last Update Date : 10/14/2022

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Directions to “ RENEE FANNING ” Practice Location

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