Basic Information
| Provider Information | |||||||||
| NPI: | 1750646733 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RENNINGER | ||||||||
| FirstName: | ALLETHAIRE | ||||||||
| MiddleName: | MEDLICOTT | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 WAKE FOREST RD | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276097317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199543000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3400 WAKE FOREST RD | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276097317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199543000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2012 | ||||||||
| LastUpdateDate: | 08/26/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 221409 | NC | Y | Nursing Service Providers | Registered Nurse |
No ID Information.