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General NPI Number Information
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NPI Number | 1619735529
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Entity Type | Individual
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Provider Name | VINCENT A RENNA
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Gender | Male
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Dates
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Enumeration Date | 03/06/2024
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Last Update Date | 04/11/2024
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Provider Practice Location Address
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Address Line | 67 MARTIN RD
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City | CONOWINGO
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State | MD
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Zip | 21918-1501
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Country | US
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Telephone | 443-616-8483
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Fax |
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Provider Business Mailing Address
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Address Line | 16A BEL AIR SOUTH PKWY STE 321
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City | BEL AIR
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State | MD
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Zip | 21015-6038
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Country | US
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Telephone | 410-561-6207
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | R245171
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License Number State | MD
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