Provider Demographics
NPI:1013375500
Name:RENNER, ARTHUR J (PA-C)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:J
Last Name:RENNER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 3RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:ND
Mailing Address - Zip Code:58540
Mailing Address - Country:US
Mailing Address - Phone:701-463-2245
Mailing Address - Fax:701-463-6543
Practice Address - Street 1:437 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:ND
Practice Address - Zip Code:58540
Practice Address - Country:US
Practice Address - Phone:701-463-2245
Practice Address - Fax:701-463-6543
Is Sole Proprietor?:No
Enumeration Date:2016-01-29
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0625363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant