MEDICARE: PAMELA LYNN RENDA CAREGIVER

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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1144018573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA LYNN RENDA CAREGIVER

Provider Business Mailing Address
First Line	:	1629 EVERETT AVE
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44514-1019
Country	:	US
Telephone Number	:	330-509-3494
Fax Number	:	330-509-3494

Provider Business Practice Location Address
First Line	:	1629 EVERETT AVE
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44514-1019
Country	:	US
Telephone Number	:	330-509-3494
Fax Number	:	330-788-6413

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

Provider Enumeration Date	:	04/26/2025
Last Update Date	:	04/26/2025

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