Provider Demographics
NPI:1649659681
Name:RENWANZ, INGRID JANE (DNP, PMHNP-BC/APRN)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:JANE
Last Name:RENWANZ
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC/APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1942 RICKENBACKER LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-9354
Mailing Address - Country:US
Mailing Address - Phone:908-361-1416
Mailing Address - Fax:
Practice Address - Street 1:15260 VENTURA BLVD STE 1200
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-5347
Practice Address - Country:US
Practice Address - Phone:310-871-0670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO09960900163W00000X
NJ26NJ00461100163WP0808X
CANP95014570363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health