Provider Demographics
NPI:1174600787
Name:WARREN, RENEE (MD)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 TEMPLE ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-3513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4021 S 700 E
Practice Address - Street 2:#300
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2192
Practice Address - Country:US
Practice Address - Phone:800-423-1605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23003207ZP0102X
MI4301050253207ZP0102X
ND6956207ZP0102X
OH35047691W207ZP0102X
VT042-0007863207ZP0102X
WI22060-020207ZP0102X
WV18101207ZP0102X
IL207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E55757Medicare UPIN