Provider Demographics
NPI:1295432987
Name:RENKEN, CATHERINE O (NP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:O
Last Name:RENKEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 SPRING VALE AVE
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3527
Mailing Address - Country:US
Mailing Address - Phone:415-793-8488
Mailing Address - Fax:
Practice Address - Street 1:8401 CONNECTICUT AVE
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-5803
Practice Address - Country:US
Practice Address - Phone:301-304-8800
Practice Address - Fax:301-652-4933
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC005182363LF0000X
VA0024186423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty