Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter |
NPI | 1932285178 |
---|---|
Provider Name | Ms. Eda Susan Renieri |
First Address | Melbourne, FL 32901 |
Second Address | Melbourne, FL 32901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 24/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1270650001 | (02) | |
44539000 | CIGNA (01) | FL |
M2733 | BLUE CROSS BLUE SHIELD FL (01) |