Renee Rachelle Bennett, RN
Individual provider Active NPI Registered Nurse · Boise, ID
NPI 1376364802 · NPPES record last updated Oct 17, 2024
Key facts
- NPI
- 1376364802
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 57148 (ID)
- Practice address
- 417 S 6TH St
Boise, ID 83702-7632 - Phone
- (479) 755-7562
- NPI assigned
- Oct 17, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 57148 | ID | MD | Registered Nurse |
| 201607206RN | OR | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 201607206RN | OR | |
| Registered Nurse | 163W00000X | 57148 | ID | Yes |
Addresses
Primary practice location
417 S 6TH St
Boise, ID 83702-7632
Mailing address
7230 S Widgi Ave
Boise, ID 83709-7394
Phone (479) 755-7562
Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.