Provider Demographics
NPI:1215483540
Name:RENFROE, NICOLE EMILIA (ATC)
Entity type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:EMILIA
Last Name:RENFROE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 CROSSWOOD WAY
Mailing Address - Street 2:APT 205
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-9790
Mailing Address - Country:US
Mailing Address - Phone:404-642-1670
Mailing Address - Fax:
Practice Address - Street 1:11200 GOVERNOR MANLY WAY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8599
Practice Address - Country:US
Practice Address - Phone:919-562-9410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-2929390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program