1144769431 NPI number — DR. JENNIFER K. RENSHAW OTD,OTRL

Table of content: DR. JENNIFER K. RENSHAW OTD,OTRL (NPI 1144769431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144769431 NPI number — DR. JENNIFER K. RENSHAW OTD,OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RENSHAW
Provider First Name:
JENNIFER
Provider Middle Name:
K.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OTD,OTRL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144769431
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5919 OLEANDER DR
Provider Second Line Business Mailing Address:
SUITE 119
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28403-4780
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-395-2995
Provider Business Mailing Address Fax Number:
910-313-0951

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5919 OLEANDER DR
Provider Second Line Business Practice Location Address:
SUITE 119
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28403-4780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-395-2995
Provider Business Practice Location Address Fax Number:
910-313-0951
Provider Enumeration Date:
02/20/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X , with the licence number:  8034 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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