Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 2013037136 | MO |
N | 207QA0401X | Family Doctor - Addiction Medicine | 2013037136 | MO |
N | 207QA0505X | Family Doctor - Adult Medicine | 2013037136 | MO |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 2013037136 | MO |
NPI | 1508179417 |
---|---|
Provider Name | Dr. Vanessa Lynn Widner Ren |
First Address | Northmoor, MO 64151-3516 |
Second Address | Northmoor, MO 64151-3516 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2010 |
Last Update Date | 20/02/2018 |