Individual
ZACHARY THOMAS RENEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
10315 DAWSONS CREEK BLVD STE AB, FORT WAYNE, IN 46825-1912
(260) 436-7875
Mailing address
PO BOX 843603, DALLAS, TX 75284-3603
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28257474A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285262329
—
IN
Enumeration date
04/01/2020
Last updated
06/24/2024
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