Healthcare Provider Details

I. General information

NPI: 1942641691
Provider Name (Legal Business Name): KATIE MAE BRENNER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATIE RITZMAN

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 S MAIN ST
ORRVILLE OH
44667-2291
US

IV. Provider business mailing address

830 S MAIN ST
ORRVILLE OH
44667-2291
US

V. Phone/Fax

Practice location:
  • Phone: 330-684-2015
  • Fax: 330-684-2075
Mailing address:
  • Phone: 330-684-2015
  • Fax: 330-684-2075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.012002
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: