Provider Demographics
NPI:1235466806
Name:RENNER, MARCIA ANN (MICROPIGMENTATION)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:ANN
Last Name:RENNER
Suffix:
Gender:F
Credentials:MICROPIGMENTATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 WASHINGTON ST
Mailing Address - Street 2:STE 320
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2609
Mailing Address - Country:US
Mailing Address - Phone:913-832-8884
Mailing Address - Fax:
Practice Address - Street 1:4010 WASHINGTON ST
Practice Address - Street 2:STE 320
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2609
Practice Address - Country:US
Practice Address - Phone:913-832-8884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008029914174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist