Healthcare Provider Details

I. General information

NPI: 1437734449
Provider Name (Legal Business Name): MARY ELIZABETH RENZE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 03/16/2024
Certification Date: 03/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3024 NEW BERN AVE STE 304
RALEIGH NC
27610-1247
US

IV. Provider business mailing address

3024 NEW BERN AVE
RALEIGH NC
27610-1247
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-7331
  • Fax:
Mailing address:
  • Phone: 919-350-7331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-11556
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: