Provider Demographics
NPI:1700862208
Name:RENNINGER, CAROL A (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
Last Name:RENNINGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W. ROMNEY PLACE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CAPE MAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08210
Mailing Address - Country:US
Mailing Address - Phone:610-442-1717
Mailing Address - Fax:
Practice Address - Street 1:1 MUNRO DR
Practice Address - Street 2:SAMUEL CALL HEALTH SERVICES CENTER
Practice Address - City:CAPE MAY
Practice Address - State:NJ
Practice Address - Zip Code:08204-5000
Practice Address - Country:US
Practice Address - Phone:609-898-6610
Practice Address - Fax:609-898-6962
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMP000749363AM0700X
MDC01976363AM0700X
PAMA002636L363AM0700X
DEC50000214363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical