Individual
JULIE RENNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
400 WESTERN AVE, SOUTH PORTLAND, ME 04106-1704
(207) 774-7111
Mailing address
400 WESTERN AVE, SOUTH PORTLAND, ME 04106-1704
(207) 774-7111
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN13441
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1922007798
—
ME
Enumeration date
04/08/2022
Last updated
04/08/2022
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