Provider Demographics
NPI:1134334675
Name:RENFREW, CYNTHIA SUE (RN,MS,FNP)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:SUE
Last Name:RENFREW
Suffix:
Gender:F
Credentials:RN,MS,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 G ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-4221
Mailing Address - Country:US
Mailing Address - Phone:707-765-2565
Mailing Address - Fax:
Practice Address - Street 1:1801 E COTATI AVE
Practice Address - Street 2:SONOMA STATE UNIVERSITY STUDENT HEALTH CENTER
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-3613
Practice Address - Country:US
Practice Address - Phone:707-664-2921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA205243363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA205243OtherLICENSE NUMBER