MEDICARE: MRS. RENEE CHRISTINE CHISUM FNP

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	363LF0000X	Family Nurse Practitioner	AP136547	TX

General Provider Information

NPI Number	:	1568967008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RENEE CHRISTINE CHISUM FNP

Provider Business Mailing Address
First Line	:	8414 SHALLOW CREEK DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-2214
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10823 TOWN CENTER DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-4585
Country	:	US
Telephone Number	:	210-509-7462
Fax Number	:

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

Provider Enumeration Date	:	03/27/2018
Last Update Date	:	02/14/2019

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