Provider Demographics
NPI:1538576517
Name:RENGO, KARI MARIE (DNP, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:MARIE
Last Name:RENGO
Suffix:
Gender:F
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:KARI
Other - Middle Name:MARIE
Other - Last Name:BEHM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:324 W SUPERIOR ST STE 600
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1722
Mailing Address - Country:US
Mailing Address - Phone:218-384-1714
Mailing Address - Fax:218-203-4152
Practice Address - Street 1:324 W SUPERIOR ST STE 600
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1722
Practice Address - Country:US
Practice Address - Phone:218-384-1714
Practice Address - Fax:218-203-4152
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI142456-30363LP0808X
MNR153390-3363LP0808X
MN2537363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1538576517Medicaid
MN1538576517Medicaid
WI1538576517Medicaid
WIK400171035Medicare PIN