Provider Demographics
NPI:1831572544
Name:RENWICK, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:RENWICK
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 1:39465 PASEO PADRE PKWY
Mailing Address - Street 2:2100
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-5350
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39465 PASEO PADRE PKWY
Practice Address - Street 2:2100
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-5350
Practice Address - Country:US
Practice Address - Phone:510-745-9151
Practice Address - Fax:510-745-9152
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program