Healthcare Provider Details

I. General information

NPI: 1649659681
Provider Name (Legal Business Name): INGRID JANE RENWANZ DNP, PMHNP-BC/APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15260 VENTURA BLVD STE 1200
SHERMAN OAKS CA
91403-5347
US

IV. Provider business mailing address

1942 RICKENBACKER LN
LINCOLN CA
95648-9354
US

V. Phone/Fax

Practice location:
  • Phone: 310-871-0670
  • Fax:
Mailing address:
  • Phone: 908-361-1416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NO09960900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number26NJ00461100
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95014570
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: