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Individual

ASHTYN RENNELS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
819 BLOOMINGTON RD, CHAMPAIGN, IL 61820-2101
(217) 356-1558
Mailing address
1202 MYRTLE BEACH AVE APT 103, CHAMPAIGN, IL 61822-2436

Taxonomy

Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
020014012
IL

Other

Enumeration date
08/23/2023
Last updated
08/23/2023
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