Healthcare Provider Details

I. General information

NPI: 1356540207
Provider Name (Legal Business Name): MICHELE C RENZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST 15 PENN TOWER
PHILADELPHIA PA
19104-4206
US

IV. Provider business mailing address

3624 MARKET ST SUITE 560W
PHILADELPHIA PA
19104-2614
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-3914
  • Fax:
Mailing address:
  • Phone: 215-662-2286
  • Fax: 215-615-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberSP009390
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: