Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 209024106 | IL |
Y | 363LN0000X | Nurse Practitioner - Neonatal | 075909 | MO |
NPI | 1083735088 |
---|---|
Provider Name | Mrs. Renee Irene Fishering |
First Address | Chesterfield, MO 63017-7264 |
Second Address | Saint Louis, MO 63110-1002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 10/01/2022 |