Provider Demographics
NPI:1609928373
Name:RENDA, SUSAN MALECKI (CRNP, CDE)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MALECKI
Last Name:RENDA
Suffix:
Gender:F
Credentials:CRNP, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N CAROLINE ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0006
Mailing Address - Country:US
Mailing Address - Phone:410-955-7140
Mailing Address - Fax:410-614-9586
Practice Address - Street 1:601 N CAROLINE ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0006
Practice Address - Country:US
Practice Address - Phone:410-955-7140
Practice Address - Fax:410-614-9586
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR085470363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD347121700Medicaid