Provider Demographics
NPI:1740802214
Name:RENOVENA HEALTH INC
Entity Type:Organization
Organization Name:RENOVENA HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WANYANA
Authorized Official - Suffix:
Authorized Official - Credentials:APN-C
Authorized Official - Phone:630-364-1316
Mailing Address - Street 1:4320 WINFIELD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-4023
Mailing Address - Country:US
Mailing Address - Phone:630-364-1316
Mailing Address - Fax:708-377-6558
Practice Address - Street 1:4320 WINFIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-4023
Practice Address - Country:US
Practice Address - Phone:630-364-1316
Practice Address - Fax:708-377-6558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2020-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty