Provider Demographics
NPI:1588360242
Name:RENKIEWICZ, LINDSEY AILEEN
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:AILEEN
Last Name:RENKIEWICZ
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 1:10060 BOULDER PASS
Mailing Address - Street 2:
Mailing Address - City:DAVISBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48350-2054
Mailing Address - Country:US
Mailing Address - Phone:248-881-4793
Mailing Address - Fax:
Practice Address - Street 1:10060 BOULDER PASS
Practice Address - Street 2:
Practice Address - City:DAVISBURG
Practice Address - State:MI
Practice Address - Zip Code:48350-2054
Practice Address - Country:US
Practice Address - Phone:248-881-4793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program