Provider Demographics
NPI:1588826846
Name:RENAK, ERIN M (PA-C, MPAP)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:M
Last Name:RENAK
Suffix:
Gender:F
Credentials:PA-C, MPAP
Other - Prefix:
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Mailing Address - Street 1:4976 S. SILVERMAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709
Mailing Address - Country:US
Mailing Address - Phone:208-995-0359
Mailing Address - Fax:208-375-0599
Practice Address - Street 1:1079 S ANCONA AVE STE 100
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-7443
Practice Address - Country:US
Practice Address - Phone:208-853-2273
Practice Address - Fax:208-376-3831
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDPA-747363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant