Healthcare Provider Details

I. General information

NPI: 1790532604
Provider Name (Legal Business Name): AMANDA RAE BRENNER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 ARCH ST # A
AKRON OH
44304-1423
US

IV. Provider business mailing address

6461 FRANK AVE NW
NORTH CANTON OH
44720-8412
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-3584
  • Fax:
Mailing address:
  • Phone: 330-433-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0036342
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0036342
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: