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Individual

MS. DANA RENICK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
200 MAPLEWOOD AVE, RONCEVERTE, WV 24970-1334
(304) 647-1161
(304) 647-3006
Mailing address
HC 68 BOX 7, RENICK, WV 24966-9732

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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