Healthcare Provider Details

I. General information

NPI: 1649085028
Provider Name (Legal Business Name): JANAE NICOLE RENSVOLD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 EUBANK BLVD NE STE 108
ALBUQUERQUE NM
87111-2565
US

IV. Provider business mailing address

321 SANDIA RD NW APT B1
ALBUQUERQUE NM
87107-5373
US

V. Phone/Fax

Practice location:
  • Phone: 505-515-6537
  • Fax:
Mailing address:
  • Phone: 505-515-6537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number83869
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: