Provider Demographics
NPI:1275377970
Name:RENEWED HEALTH
Entity type:Organization
Organization Name:RENEWED HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:612-710-9176
Mailing Address - Street 1:1800 MENDON RD STE E166
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-4391
Mailing Address - Country:US
Mailing Address - Phone:401-680-0393
Mailing Address - Fax:267-367-5920
Practice Address - Street 1:2374 DIAMOND HILL RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-4744
Practice Address - Country:US
Practice Address - Phone:401-680-0393
Practice Address - Fax:267-367-5920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty