Provider Demographics
NPI:1659020170
Name:RENSHAW, NICOLE JANETTE
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:JANETTE
Last Name:RENSHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15725 RICHARD DR
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-3367
Mailing Address - Country:US
Mailing Address - Phone:216-399-9567
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:15725 RICHARD DR
Practice Address - Street 2:
Practice Address - City:BROOKPARK
Practice Address - State:OH
Practice Address - Zip Code:44142-3367
Practice Address - Country:US
Practice Address - Phone:216-399-9567
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide