Provider Demographics
NPI:1801372800
Name:RENFROW, MARY GRACE (DNP, CRNP)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:GRACE
Last Name:RENFROW
Suffix:
Gender:F
Credentials:DNP, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:207 BLENHEIM RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-1704
Mailing Address - Country:US
Mailing Address - Phone:410-812-5448
Mailing Address - Fax:
Practice Address - Street 1:7505 OSLER DR STE 502
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7740
Practice Address - Country:US
Practice Address - Phone:410-296-4210
Practice Address - Fax:443-276-5865
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR206254363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner