MEDICARE: TERESA ANN RENNICK PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	OOO32868	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487860383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA ANN RENNICK PMHNP

Provider Business Mailing Address
First Line	:	3314 VANDENBERG RD
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-3730
Country	:	US
Telephone Number	:	541-882-7291
Fax Number	:	541-883-4213

Provider Business Practice Location Address
First Line	:	3314 VANDENBERG RD
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-3730
Country	:	US
Telephone Number	:	541-882-7291
Fax Number	:	541-883-4213

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/09/2007

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