Provider Demographics
NPI:1487022810
Name:RENFROW, HANNAH (NP-C)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:RENFROW
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 W BELLA DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953
Mailing Address - Country:US
Mailing Address - Phone:765-651-6637
Mailing Address - Fax:765-651-6639
Practice Address - Street 1:1411 W BELLA DRIVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953
Practice Address - Country:US
Practice Address - Phone:765-651-6637
Practice Address - Fax:765-651-6639
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28192587A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics