Healthcare Provider Details

I. General information

NPI: 1477465417
Provider Name (Legal Business Name): VANESSA RENTERIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1917 KEENEY ST
EVANSTON IL
60202-1937
US

IV. Provider business mailing address

1917 KEENEY ST
EVANSTON IL
60202-1937
US

V. Phone/Fax

Practice location:
  • Phone: 847-800-4697
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License NumberR53687789839
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: