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General NPI Number Information
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NPI Number | 1801616354
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Entity Type | Organization
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Legal Business Name | RENEW SPECIALITY GROUP
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Dates
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Enumeration Date | 10/10/2024
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 18805 W CATAWBA AVE STE 100
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City | CORNELIUS
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State | NC
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Zip | 28031-4608
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Country | US
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Telephone | 704-612-0011
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Fax | 704-612-0012
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Provider Business Mailing Address
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Address Line | 18805 W CATAWBA AVE STE 100
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City | CORNELIUS
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State | NC
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Zip | 28031-4608
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Country | US
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Telephone | 704-612-0011
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Fax | 704-612-0012
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Authorized Official
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Title or Position | OWNER
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Name | CORAL D KIRSCHER
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Credential | DNP, FNP-C
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Telephone | 704-612-0011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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