Provider Demographics
NPI:1053956797
Name:BASHAM, RENEE ELIZABETH (CD(BAI))
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:ELIZABETH
Last Name:BASHAM
Suffix:
Gender:F
Credentials:CD(BAI)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 BAYBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-7106
Mailing Address - Country:US
Mailing Address - Phone:859-806-0582
Mailing Address - Fax:
Practice Address - Street 1:138 BAYBROOK CIR
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-7106
Practice Address - Country:US
Practice Address - Phone:859-806-0582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula