Provider Demographics
NPI:1902327125
Name:RENZY, OLIVIA MICHELLE
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MICHELLE
Last Name:RENZY
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 1:180 GRAFTON LN
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22611-2576
Mailing Address - Country:US
Mailing Address - Phone:540-955-2400
Mailing Address - Fax:
Practice Address - Street 1:180 GRAFTON LN
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:VA
Practice Address - Zip Code:22611-2576
Practice Address - Country:US
Practice Address - Phone:540-955-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide