| Doctor Name: | KRISTOPHER RENZI |
| NPI Number: | 1164876447 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 71006295A |
| Business Practice Address: | 9660 Wicker Ave Saint John, IN - 463739487 |
| Business Phone Number: | 2193651177 |
| Business Fax Number: | 2197036662 |
| Mailing Address: | 9660 Wicker Ave, SAINT JOHN |
| State: | IN |
| Postal Code: | 463739487 |
| Phone Number: | 2193651177 |
| Fax Number: | 2197036662 |
| NPI Enumeration Date: | 04/22/2016 |
| NPI Last Update Date: | 06/06/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 71006295A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |