Healthcare Provider Details

I. General information

NPI: 1487735353
Provider Name (Legal Business Name): CATHERINE RAE RENK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 WEST ST SUITE 211
PERU IL
61354-2763
US

IV. Provider business mailing address

914 30TH ST
PERU IL
61354-1454
US

V. Phone/Fax

Practice location:
  • Phone: 815-223-2143
  • Fax:
Mailing address:
  • Phone: 815-224-4138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: