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General NPI Number Information
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NPI Number | 1356177240
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Entity Type | Organization
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Legal Business Name | RENEW HEALTH AND WELLNESS
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 2001 W TREVI PL
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City | SIOUX FALLS
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State | SD
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Zip | 57108-7504
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Country | US
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Telephone | 605-777-1495
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Fax |
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Provider Business Mailing Address
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Address Line | 25271 475TH AVE
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City | BALTIC
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State | SD
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Zip | 57003-5943
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER ANN REDMOND
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Credential | DNP
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Telephone | 605-261-6872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number |
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License Number State |
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