Provider Demographics
NPI:1790147122
Name:RENZE, LINDA KAYE
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:KAYE
Last Name:RENZE
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 1:2795 100TH ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-3863
Mailing Address - Country:US
Mailing Address - Phone:515-727-1406
Mailing Address - Fax:515-727-1409
Practice Address - Street 1:2795 100TH ST
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-3863
Practice Address - Country:US
Practice Address - Phone:515-727-1406
Practice Address - Fax:515-727-1409
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist