Basic Information
Provider Information | |||||||||
NPI: | 1891921045 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | RENOWN HOSPITALIST GROUP | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 780 KUENZLI ST | ||||||||
Address2: | SUITE 202 | ||||||||
City: | RENO | ||||||||
State: | NV | ||||||||
PostalCode: | 895021011 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7759824590 | ||||||||
FaxNumber: | 7759824595 | ||||||||
Practice Location | |||||||||
Address1: | 1155 MILL ST | ||||||||
Address2: | MAIL CODE B-31 | ||||||||
City: | RENO | ||||||||
State: | NV | ||||||||
PostalCode: | 895021576 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7759827878 | ||||||||
FaxNumber: | 7759824196 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/02/2009 | ||||||||
LastUpdateDate: | 07/22/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | AHNER | ||||||||
AuthorizedOfficialFirstName: | DAWN | ||||||||
AuthorizedOfficialMiddleName: | D | ||||||||
AuthorizedOfficialTitleorPosition: | CFO | ||||||||
AuthorizedOfficialTelephone: | 7759824404 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.