Healthcare Provider Details

I. General information

NPI: 1699101006
Provider Name (Legal Business Name): KARI LYNNE RENNER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 W KINNICKINNIC RIVER PKWY SUITE #511
MILWAUKEE WI
53215-3677
US

IV. Provider business mailing address

2901 W KINNICKINNIC RIVER PKWY SUITE #511
MILWAUKEE WI
53215-3677
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-3780
  • Fax: 414-649-3794
Mailing address:
  • Phone: 414-649-3780
  • Fax: 414-649-3794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5467-33
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5467-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: