Provider Demographics
NPI:1669365466
Name:RENNON, VALERIE LOPEZ (NP RN)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:LOPEZ
Last Name:RENNON
Suffix:
Gender:F
Credentials:NP RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34317 DANTE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-3286
Mailing Address - Country:US
Mailing Address - Phone:972-998-3641
Mailing Address - Fax:
Practice Address - Street 1:44575 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1139
Practice Address - Country:US
Practice Address - Phone:586-445-7999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI104756825363L00000X
MI4704366316163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner