Provider Demographics
NPI:1053461558
Name:RENNICK, KARRIE (RN)
Entity Type:Individual
Prefix:
First Name:KARRIE
Middle Name:
Last Name:RENNICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 VINEYARD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-1743
Mailing Address - Country:US
Mailing Address - Phone:650-306-1100
Mailing Address - Fax:
Practice Address - Street 1:643 BLAIR ISLAND RD
Practice Address - Street 2:STE 106
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063
Practice Address - Country:US
Practice Address - Phone:650-306-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA445315163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse