Provider Demographics
NPI:1821399007
Name:RENSCH, MONICA MARIE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:MARIE
Last Name:RENSCH
Suffix:
Gender:F
Credentials:COTA/L
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 2536
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58502-2536
Mailing Address - Country:US
Mailing Address - Phone:701-258-1569
Mailing Address - Fax:701-223-1669
Practice Address - Street 1:107 W MAIN AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3890
Practice Address - Country:US
Practice Address - Phone:701-258-1569
Practice Address - Fax:701-223-1669
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND850174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist