Provider Demographics
NPI:1487735353
Name:RENK, CATHERINE RAE
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:RAE
Last Name:RENK
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 1:914 30TH ST
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-1454
Mailing Address - Country:US
Mailing Address - Phone:815-224-4138
Mailing Address - Fax:
Practice Address - Street 1:920 WEST ST
Practice Address - Street 2:SUITE 211
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-2763
Practice Address - Country:US
Practice Address - Phone:815-223-2143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL068623OtherHEALTH ALLIANCE
IL068623OtherHEALTH ALLIANCE
IL201340Medicare PIN