Provider Demographics
NPI:1154614113
Name:RENZ, HEATHER M (LMP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:RENZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7304 E MAXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-1174
Mailing Address - Country:US
Mailing Address - Phone:509-951-8211
Mailing Address - Fax:
Practice Address - Street 1:7304 E MAXWELL AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-1174
Practice Address - Country:US
Practice Address - Phone:509-951-8211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60212153174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist