Provider Demographics
NPI:1306641311
Name:RENZO, DONALD MELTON (FNP-BC)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:MELTON
Last Name:RENZO
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 WOODCLOUGH CT
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-7804
Mailing Address - Country:US
Mailing Address - Phone:704-277-9907
Mailing Address - Fax:
Practice Address - Street 1:2101 WOODCLOUGH CT
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-7804
Practice Address - Country:US
Practice Address - Phone:704-277-9907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC352352163WE0003X
NC5021715363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency