Healthcare Provider Details

I. General information

NPI: 1699622530
Provider Name (Legal Business Name): RENU PROSTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3818 W 19TH ST
LITTLE ROCK AR
72204-3914
US

IV. Provider business mailing address

3818 W 19TH ST
LITTLE ROCK AR
72204-3914
US

V. Phone/Fax

Practice location:
  • Phone: 501-404-8451
  • Fax:
Mailing address:
  • Phone: 501-404-8451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. BRITTANY SHONTAY MAXWELL
Title or Position: OWNER
Credential:
Phone: 501-291-6002