Provider Demographics
NPI:1831481233
Name:RENALDI, JANET E (RN)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:E
Last Name:RENALDI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 N COLLEGE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3486
Mailing Address - Country:US
Mailing Address - Phone:208-736-6218
Mailing Address - Fax:208-732-0206
Practice Address - Street 1:746 N COLLEGE RD
Practice Address - Street 2:SUITE A
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3486
Practice Address - Country:US
Practice Address - Phone:208-736-6218
Practice Address - Fax:208-732-0206
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN17707163WD0400X
IDNP1069A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID11361991Medicare PIN