Renee Elizabeth Anderson

Primary specialty

SpecialistTaxonomy code 174400000X

License

1630473221 Issued in NY

Practice address

10 St Patrick PL
Port Henry, NY 12974-1200

Phone

(518) 546-3381

Fax

(518) 546-3768

NPI assigned

Oct 12, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Renee Elizabeth Couture Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1665532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665532800000",
    "number": "1952027955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 ST PATRICK PL",
            "city": "PORT HENRY",
            "state": "NY",
            "postal_code": "129741200",
            "telephone_number": "518-546-3381",
            "fax_number": "518-546-3768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 ST PATRICK PL",
            "city": "PORT HENRY",
            "state": "NY",
            "postal_code": "129741200",
            "telephone_number": "518-546-3381",
            "fax_number": "518-546-3768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "RENEE",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-12",
        "last_updated": "2022-10-12",
        "certification_date": "2022-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "1630473221",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS EMERGENCY COVID-19",
            "identifier": "1630473221",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "randerson@mountainlakeservices.org",
            "affiliation": "N",
            "address_1": "10 St Patrick Pl",
            "city": "Port Henry",
            "state": "NY",
            "country_code": "US",
            "postal_code": "129741200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "RENEE",
            "last_name": "COUTURE",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Specialist in Port Henry, NY
• Providers in Port Henry, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 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.

Verify at the official NPI Registry.