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Individual
MS. DANA RENICK
Active
Individual
MS. DANA RENICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
DO-154
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23/49/50
MTST BCBS
WV
01
—
P00135101
RAILROAD MEDICARE
WV
Enumeration date
07/09/2006
Last updated
07/08/2007
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