Provider Demographics
NPI:1053593020
Name:WORRELL, RENEE MARIE (MSN, CNM)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:MARIE
Last Name:WORRELL
Suffix:
Gender:F
Credentials:MSN, CNM
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:MARIE
Other - Last Name:SISK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2275 W JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2114
Mailing Address - Country:US
Mailing Address - Phone:734-675-7210
Mailing Address - Fax:734-675-3023
Practice Address - Street 1:2275 W JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2114
Practice Address - Country:US
Practice Address - Phone:734-675-7210
Practice Address - Fax:734-675-3023
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704193908176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P32150019Medicare PIN