Healthcare Provider Details

I. General information

NPI: 1861482697
Provider Name (Legal Business Name): TERRI ANN RENSCH CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 LAS VEGAS BLVD N
LAS VEGAS NV
89191-6600
US

IV. Provider business mailing address

4451 CRIMSON TIDE AVE
NORTH LAS VEGAS NV
89031-0452
US

V. Phone/Fax

Practice location:
  • Phone: 702-653-2300
  • Fax:
Mailing address:
  • Phone: 702-653-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number2188564402
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: