Provider Demographics
NPI:1871323469
Name:RENNEKE, CATHERINE ANGELA (RN)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANGELA
Last Name:RENNEKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:596 6TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:MN
Mailing Address - Zip Code:55055-1361
Mailing Address - Country:US
Mailing Address - Phone:715-533-9169
Mailing Address - Fax:
Practice Address - Street 1:824 MILLWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1928
Practice Address - Country:US
Practice Address - Phone:651-338-1031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2510614163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty