Provider Demographics
NPI:1265279970
Name:RENNEKAMP, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:RENNEKAMP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13002 PINE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LEON
Mailing Address - State:IN
Mailing Address - Zip Code:47012-9333
Mailing Address - Country:US
Mailing Address - Phone:513-262-3641
Mailing Address - Fax:
Practice Address - Street 1:3188 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2369
Practice Address - Country:US
Practice Address - Phone:513-584-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2025-12-04
Deactivation Date:2024-07-19
Deactivation Code:
Reactivation Date:2025-12-04
Provider Licenses
StateLicense IDTaxonomies
OH430135163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse