Provider Demographics
NPI:1427825355
Name:RENSHAW, ERIN TAYLOR
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:TAYLOR
Last Name:RENSHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 RODERICK RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-3716
Mailing Address - Country:US
Mailing Address - Phone:260-437-9615
Mailing Address - Fax:
Practice Address - Street 1:3600 RODERICK RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-3716
Practice Address - Country:US
Practice Address - Phone:260-437-9615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2023058500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily