Provider Demographics
NPI:1710900139
Name:RENELLA, CATHERINE DENISE (ARNP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:DENISE
Last Name:RENELLA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4590 W 121ST AVE
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-5666
Mailing Address - Country:US
Mailing Address - Phone:303-439-4544
Mailing Address - Fax:
Practice Address - Street 1:4590 W 121ST AVE
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-5666
Practice Address - Country:US
Practice Address - Phone:303-439-4544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2019-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005849363L00000X
COAPN.0003117363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner