Provider Demographics
NPI:1457356222
Name:RENZ, MARY-JO (ARNP)
Entity type:Individual
Prefix:
First Name:MARY-JO
Middle Name:
Last Name:RENZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33450
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-0450
Mailing Address - Country:US
Mailing Address - Phone:206-368-1244
Mailing Address - Fax:206-368-1270
Practice Address - Street 1:1560 N 115TH ST STE 201
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8414
Practice Address - Country:US
Practice Address - Phone:206-368-1244
Practice Address - Fax:206-368-1270
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30002251363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00135135OtherRAILROAD MEDICARE
WA9629858Medicaid
WAP00135135OtherRAILROAD MEDICARE
WAP34464Medicare UPIN