Provider Demographics
NPI:1689853921
Name:RENZ, SUSAN M (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:RENZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 525
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-0525
Mailing Address - Country:US
Mailing Address - Phone:610-323-3100
Mailing Address - Fax:
Practice Address - Street 1:13 ARMAND HAMMER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-5067
Practice Address - Country:US
Practice Address - Phone:610-323-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP001613H363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care