MEDICARE: THOMAS RENK PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	13799	WI

General Provider Information

NPI Number	:	1023713039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS RENK PMHNP

Provider Business Mailing Address
First Line	:	1351 ONTARIO RD
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-8302
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1351 ONTARIO RD
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-8302
Country	:	US
Telephone Number	:	920-328-1220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2023
Last Update Date	:	03/31/2023

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