Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | APRN.CNP.019380 | OH |
NPI | 1003479080 |
---|---|
Provider Name | Jaime Marie Rennecker |
First Address | Canton, OH 44710-1702 |
Second Address | Canton, OH 44710-1702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2019 |
Last Update Date | 08/07/2019 |