Provider Demographics
NPI:1376182725
Name:RENOIS ANTWI, BRIANA (NP)
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:
Last Name:RENOIS ANTWI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7836 PENROSE AVE APT B
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1024
Mailing Address - Country:US
Mailing Address - Phone:917-588-8492
Mailing Address - Fax:
Practice Address - Street 1:23 BUSTLETON PIKE
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6446
Practice Address - Country:US
Practice Address - Phone:215-464-0770
Practice Address - Fax:267-579-0720
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN700326163W00000X
PASP020982363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse