Healthcare Provider Details

I. General information

NPI: 1962171793
Provider Name (Legal Business Name): JANICA RENEE' WREN MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/07/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4073 PLEASANT VALLEY
CANFIELD OH
44406-2888
US

IV. Provider business mailing address

3375 CANFIELD RD UNIT 2934
YOUNGSTOWN OH
44511-2888
US

V. Phone/Fax

Practice location:
  • Phone: 216-647-1601
  • Fax:
Mailing address:
  • Phone: 216-647-1601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0029513
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: