Individual
FRED H. RENCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1400 E. KINCAID STREET, MOUNT VERNON, WA 98274-4127
(360) 428-2586
(360) 428-6470
Mailing address
1400 E. KINCAID STREET, ATTN: CREDENTIALING, MOUNT VERNON, WA 98274-4127
(360) 428-2500
(360) 428-6485
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10003130
WA
363AS0400X
Surgical Physician Assistant
PA00003130
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1022277
—
WA
01
—
263689
LABOR & INDUSTRIES
WA
05
—
8200024
—
WA
Enumeration date
04/14/2006
Last updated
06/17/2015
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