Individual
BRENTNY RENFRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2905 N MAIN ST, DECATUR, IL 62526-4274
(217) 877-6111
Mailing address
2905 N MAIN ST, DECATUR, IL 62526-4274
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.005105
IL
Other
Enumeration date
08/05/2014
Last updated
08/05/2014
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