Provider Demographics
NPI:1902632383
Name:RENICKER, GLORIA A
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:A
Last Name:RENICKER
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 1:314 LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:DENNISON
Mailing Address - State:OH
Mailing Address - Zip Code:44621-1440
Mailing Address - Country:US
Mailing Address - Phone:330-556-8031
Mailing Address - Fax:
Practice Address - Street 1:314 LOGAN ST
Practice Address - Street 2:
Practice Address - City:DENNISON
Practice Address - State:OH
Practice Address - Zip Code:44621-1440
Practice Address - Country:US
Practice Address - Phone:330-556-8031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker