Healthcare Provider Details

I. General information

NPI: 1457356222
Provider Name (Legal Business Name): MARY-JO RENZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 N 115TH ST STE 201
SEATTLE WA
98133-8414
US

IV. Provider business mailing address

PO BOX 33450
SEATTLE WA
98133-0450
US

V. Phone/Fax

Practice location:
  • Phone: 206-368-1244
  • Fax: 206-368-1270
Mailing address:
  • Phone: 206-368-1244
  • Fax: 206-368-1270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP30002251
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: