Provider Demographics
NPI:1912283250
Name:RENKO, MICHELLE GENE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:GENE
Last Name:RENKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3900
Mailing Address - Country:US
Mailing Address - Phone:740-206-7131
Mailing Address - Fax:740-422-0711
Practice Address - Street 1:609 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3900
Practice Address - Country:US
Practice Address - Phone:740-206-7131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN-CNP.0028425363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty