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Individual

MS. LISA RENE RENO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NURSE PRACTITIONER

Contact information

Practice address
1414 CROSS ST STE 210, SHILOH, IL 62269-2988
(618) 607-1260
(618) 624-4865
Mailing address
1414 CROSS ST STE 210, SHILOH, IL 62269-2988
(618) 607-1260
(618) 624-4865

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
209004280
IL
363LF0000X
Family Nurse Practitioner
Primary
209004280
IL

Other

Enumeration date
07/12/2006
Last updated
03/12/2021
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