Healthcare Provider Details

I. General information

NPI: 1295163954
Provider Name (Legal Business Name): CHARLOTTE CATHERINE RENSBERGER P.N.P.- P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2013
Last Update Date: 11/27/2023
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 JOHN ST SUITE E-352
KALAMAZOO MI
49007-5341
US

IV. Provider business mailing address

601 JOHN ST SUITE E-352
KALAMAZOO MI
49007-5341
US

V. Phone/Fax

Practice location:
  • Phone: 269-341-8986
  • Fax: 269-341-6236
Mailing address:
  • Phone: 269-341-8986
  • Fax: 269-341-6236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704239318
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: