MEDICARE: CHRISTOPHER MICHAEL RENZI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	SP017045	PA

General Provider Information

NPI Number	:	1285179390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER MICHAEL RENZI

Provider Business Mailing Address
First Line	:	1324 W. RITNER STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1324 W RITNER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-3535
Country	:	US
Telephone Number	:	267-773-7311
Fax Number	:	267-773-7311

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2016
Last Update Date	:	12/28/2016

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