Provider Demographics
NPI:1588392161
Name:SCHRENK, CAROLYN ANN
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANN
Last Name:SCHRENK
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 1:703 5TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-4802
Mailing Address - Country:US
Mailing Address - Phone:170-136-8196
Mailing Address - Fax:
Practice Address - Street 1:703 5TH AVE SE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-4802
Practice Address - Country:US
Practice Address - Phone:701-368-1964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND030862Medicaid