Healthcare Provider Details

I. General information

NPI: 1508470519
Provider Name (Legal Business Name): MRS. YAN ZHAO RENNINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2020
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4488 W BROAD ST STE 3
COLUMBUS OH
43228-5610
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 614-453-1589
  • Fax: 614-853-8570
Mailing address:
  • Phone: 614-788-5400
  • Fax: 614-788-5500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.024600
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: