Healthcare Provider Details

I. General information

NPI: 1831152420
Provider Name (Legal Business Name): JOANNE M RENNA LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 E DAKOTA AVE
DENVER CO
80209-1514
US

IV. Provider business mailing address

33 E DAKOTA AVE
DENVER CO
80209-1514
US

V. Phone/Fax

Practice location:
  • Phone: 303-871-9174
  • Fax:
Mailing address:
  • Phone: 303-871-9174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number763
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: