Individual
HEATH RUSSELL RENNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3366 OAKDALE AVE N, SUITE 103, ROBBINSDALE, MN 55422-2948
(763) 520-7870
(763) 520-7580
Mailing address
6465 WAYZATA BLVD, SUITE 900, ST LOUIS PARK, MN 55426-1728
(952) 512-5600
(952) 512-5650
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9757
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
065G8RE
BLUECROSS BLUESHIELD
—
01
—
116980
MEDICA
—
01
—
13138C564
UCARE
—
01
—
969991033651
PREFERREDONE
—
01
—
HP39821
HEALTHPARTNERS
—
Enumeration date
08/10/2006
Last updated
07/11/2007
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