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Individual

BEVERLY GAYLE RENICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP PA-C

Contact information

Practice address
450 STANYAN, 2ND FLOOR USF STUDENT MEDICAL CLINIC ST MARYS MEDICAL C, SAN FRANCISCO, CA 94117-1079
(415) 750-4980
(415) 750-8155
Mailing address
779 PORT WALK PLACE, REDWOOD CITY, CA 94065
(650) 622-9943

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA13272
CA
363LF0000X
Family Nurse Practitioner
272543
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0PA132720
PPIN
CA
Enumeration date
01/04/2006
Last updated
09/23/2013
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