Active NPI
Renee Willard
- Other Technician
- Jackson, MI
National Provider Identifier
1639820574
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- Practice address
- 1001 Laurence Ave
Jackson, MI 49202-2979 - Phone
- (517) 750-4777
- NPI assigned
- Jan 12, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | Primary |
Addresses
Primary practice location
1001 Laurence Ave
Jackson, MI 49202-2979
Mailing address
9580 Tompkins Rd
Rives Junction, MI 49277-9625
Phone (517) 525-4359
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1641945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641945600000",
"number": "1639820574",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9580 TOMPKINS RD",
"city": "RIVES JUNCTION",
"state": "MI",
"postal_code": "492779625",
"telephone_number": "517-525-4359"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 LAURENCE AVE",
"city": "JACKSON",
"state": "MI",
"postal_code": "492022979",
"telephone_number": "517-750-4777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLARD",
"first_name": "RENEE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-01-12",
"last_updated": "2022-01-12",
"certification_date": "2022-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.