Basic Information
| Provider Information | |||||||||
| NPI: | 1780646398 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | URSUY | ||||||||
| FirstName: | RENEE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | P.A.-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2715 TAVERN CT | ||||||||
| Address2: | |||||||||
| City: | JAMESTOWN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272829586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7863380478 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1126 N CHURCH ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3369380800 | ||||||||
| FaxNumber: | 3369380755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2006 | ||||||||
| LastUpdateDate: | 08/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA 9102524 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.