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NPI Code Detail

MEDICARE: CHARLES RENICK

MEDICARE: CHARLES RENICK
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
1103T00000XPsychologist
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1629470026
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES RENICK
Provider Business Mailing Address
First Line : 3406 GLACIER HWY
Second Line :
City : JUNEAU
State : AK
Zip : 99801-7251
Country : US
Telephone Number : 907-463-3303
Fax Number :
Provider Business Practice Location Address
First Line : 3406 GLACIER HWY
Second Line :
City : JUNEAU
State : AK
Zip : 99801-7251
Country : US
Telephone Number : 907-463-3303
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2014
Last Update Date : 04/22/2024

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Directions to “ CHARLES RENICK ” Practice Location

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