Provider Demographics
NPI:1942006978
Name:RENZ, KARLY RAE
Entity type:Individual
Prefix:
First Name:KARLY
Middle Name:RAE
Last Name:RENZ
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 1:6425 COUNTY ROAD 330
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-9629
Mailing Address - Country:US
Mailing Address - Phone:419-701-9576
Mailing Address - Fax:
Practice Address - Street 1:6425 COUNTY ROAD 330
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-9629
Practice Address - Country:US
Practice Address - Phone:419-701-9576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver