Basic Information
| Provider Information | |||||||||
| NPI: | 1992987101 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RENAISSANCE WOMEN'S CENTER, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P O BOX 281466 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372281466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153130046 | ||||||||
| FaxNumber: | 6152549747 | ||||||||
| Practice Location | |||||||||
| Address1: | 131 FRENCH LANDING DR | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372281511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153130046 | ||||||||
| FaxNumber: | 6152549747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2007 | ||||||||
| LastUpdateDate: | 11/29/2007 | ||||||||
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| AuthorizedOfficialLastName: | SWEET | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
| AuthorizedOfficialMiddleName: | DIANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6153130046 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | 27001 | TN | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
ID Information
| ID | Type | State | Issuer | Description | 3093581 | 05 | TN | MEDICAID |