| Doctor Name: | JOSE LUIS RENTERIA |
| NPI Number: | 1053704361 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ACNP |
| License Number: | 53-76710-092 |
| Business Practice Address: | 1905 19th St Great Bend, KS - 675302502 |
| Business Phone Number: | 6207925700 |
| Business Fax Number: | |
| Mailing Address: | 1718 Odell St, GREAT BEND |
| State: | KS |
| Postal Code: | 675302419 |
| Phone Number: | 6207868783 |
| Fax Number: | |
| NPI Enumeration Date: | 03/11/2015 |
| NPI Last Update Date: | 03/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2100X |
| License Number: | 53-76710-092 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |