Provider Demographics
NPI:1427460039
Name:RENGEL, COURTNEY N (APRN-CRNA)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:N
Last Name:RENGEL
Suffix:
Gender:F
Credentials:APRN-CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1822
Mailing Address - Country:US
Mailing Address - Phone:220-564-4218
Mailing Address - Fax:220-564-4217
Practice Address - Street 1:1320 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1822
Practice Address - Country:US
Practice Address - Phone:220-564-4218
Practice Address - Fax:220-564-4217
Is Sole Proprietor?:No
Enumeration Date:2014-05-30
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CRNA.16011367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN 334507OtherRN OHIO LICENSE
OH0104392Medicaid
OHCOA16011NAOtherCRNA LICENSE
OHP01338264OtherRAILROAD MEDICARE
OHRN 334507OtherRN OHIO LICENSE