Individual
RENE A FERNETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
295 PHALEN BLVD, SAINT PAUL, MN 55130-2400
(651) 495-6600
(952) 883-9677
Mailing address
PO BOX 1309 - 8170 33RD AVE S, MS 21110Q, MINNEAPOLIS, MN 55425-4516
(651) 254-3490
(651) 254-7033
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11636
MN
363A00000X
Physician Assistant
1640
OK
363A00000X
Physician Assistant
2455
WI
363AS0400X
Surgical Physician Assistant
5601002403
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1932189636
—
WI
05
—
200116670A
—
OK
Enumeration date
01/19/2006
Last updated
05/26/2022
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