Provider Demographics
NPI:1689083438
Name:RENSEL, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:RENSEL
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 1:3109 35TH AVE UNIT A102
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-9479
Mailing Address - Country:US
Mailing Address - Phone:303-209-6371
Mailing Address - Fax:877-325-2102
Practice Address - Street 1:3109 35TH AVE UNIT A102
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-9479
Practice Address - Country:US
Practice Address - Phone:303-209-6371
Practice Address - Fax:877-325-2102
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991245.NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner