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NPI Code Detail

MEDICARE: MS. RENAE LYNN ST.CLAIR ATC

MEDICARE:  MS. RENAE LYNN ST.CLAIR  ATC
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
1174400000XSpecialistIL

General Provider Information

NPI Number : 1881669547
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. RENAE LYNN ST.CLAIR ATC
Provider Business Mailing Address
First Line : PO BOX 862
Second Line : 742 KRESSWOOD DR.
City : MCHENRY
State : IL
Zip : 60051-9014
Country : US
Telephone Number : 815-403-6614
Fax Number :
Provider Business Practice Location Address
First Line : 8311 N ROUTE 31
Second Line :
City : RICHMOND
State : IL
Zip : 60071
Country : US
Telephone Number : 815-678-7561
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2006
Last Update Date : 07/08/2007

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Directions to “ MS. RENAE LYNN ST.CLAIR ATC” Practice Location

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