Provider Demographics
NPI:1215521331
Name:RENNAKER, MARIA LYN (PA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LYN
Last Name:RENNAKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:LYN
Other - Last Name:CRESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3334 DVN LN
Mailing Address - Street 2:
Mailing Address - City:DARBY
Mailing Address - State:MT
Mailing Address - Zip Code:59829-9736
Mailing Address - Country:US
Mailing Address - Phone:406-381-2713
Mailing Address - Fax:
Practice Address - Street 1:3334 DVN LN
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:MT
Practice Address - Zip Code:59829-9736
Practice Address - Country:US
Practice Address - Phone:406-375-4142
Practice Address - Fax:406-375-4143
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT91830363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant