MEDICARE: RENEE MAYWEATHER

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1790159226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE MAYWEATHER

Provider Business Mailing Address
First Line	:	3919 WASHINGTON BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-3507
Country	:	US
Telephone Number	:	618-580-6801
Fax Number	:

Provider Business Practice Location Address
First Line	:	3919 WASHINGTON BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-3507
Country	:	US
Telephone Number	:	618-580-6801
Fax Number	:

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

Provider Enumeration Date	:	11/20/2015
Last Update Date	:	11/20/2015

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Directions to “ RENEE MAYWEATHER ” Practice Location

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