Provider Demographics
NPI:1568659910
Name:RENK, ERIC LLOYD (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:LLOYD
Last Name:RENK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 BRISTOL CT SW
Mailing Address - Street 2:A104
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-6003
Mailing Address - Country:US
Mailing Address - Phone:360-819-4289
Mailing Address - Fax:
Practice Address - Street 1:2401 BRISTOL CT SW
Practice Address - Street 2:A104
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-6003
Practice Address - Country:US
Practice Address - Phone:360-819-4289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005283363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMR3027201OtherDEA