Provider Demographics
NPI:1437430279
Name:EARHART, RENEE
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:EARHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 STEPHEN MOODY ST SE
Mailing Address - Street 2:APT. 1436
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-1992
Mailing Address - Country:US
Mailing Address - Phone:505-433-3773
Mailing Address - Fax:
Practice Address - Street 1:701 STEPHEN MOODY ST SE
Practice Address - Street 2:APT. 1436
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-1992
Practice Address - Country:US
Practice Address - Phone:505-433-3773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist