Provider Demographics
NPI:1295081834
Name:RENZI, MARIE (FNP-BC)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:RENZI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4923 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2081
Mailing Address - Country:US
Mailing Address - Phone:302-225-0451
Mailing Address - Fax:302-225-0472
Practice Address - Street 1:201 W LIBERTY WAY
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-5399
Practice Address - Country:US
Practice Address - Phone:302-424-3694
Practice Address - Fax:302-424-3697
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0000626363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1295081834Medicaid