MEDICARE: MARY-JO RENZ ARNP

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	363LG0600X	Gerontology Nurse Practitioner	AP30002251	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00135135	OTHER	WA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457356222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY-JO RENZ ARNP

Provider Business Mailing Address
First Line	:	PO BOX 33450
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98133-0450
Country	:	US
Telephone Number	:	206-368-1244
Fax Number	:	206-368-1270

Provider Business Practice Location Address
First Line	:	1560 N 115TH ST STE 201
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98133-8414
Country	:	US
Telephone Number	:	206-368-1244
Fax Number	:	206-368-1270

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	09/08/2008

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