Individual
JOSE LUIS RENTERIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ACNP
Contact information
Practice address
1905 19TH ST, GREAT BEND, KS 67530-2502
(620) 792-5700
Mailing address
1718 ODELL ST, GREAT BEND, KS 67530-2419
(620) 786-8783
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
53-76710-092
KS
Other
Enumeration date
03/11/2015
Last updated
03/16/2015
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