Basic Information
| Provider Information | |||||||||
| NPI: | 1770695967 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RENZ | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | NP RN CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 361 THIRD STREET | ||||||||
| Address2: | |||||||||
| City: | SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154994030 | ||||||||
| FaxNumber: | 4155072634 | ||||||||
| Practice Location | |||||||||
| Address1: | 361 THIRD STREET | ||||||||
| Address2: | |||||||||
| City: | SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154994030 | ||||||||
| FaxNumber: | 4155072634 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 163WW0101X | 622677 | CA | X | Nursing Service Providers | Registered Nurse | Women's Health Care, Ambulatory | 363LW0102X | 15767 | CA | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 367A00000X | 1693 | CA | X | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.