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General NPI Number Information
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NPI Number | 1457878266
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Entity Type | Individual
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Provider Name | GREGORY ALLEN BRESNAHAN CNP
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Gender | Male
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Dates
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Enumeration Date | 08/23/2017
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Last Update Date | 08/23/2017
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Provider Practice Location Address
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Address Line | 1350 E MARKET ST
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City | WARREN
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State | OH
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Zip | 44483-6608
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Country | US
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Telephone | 330-841-9221
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Fax |
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Provider Business Mailing Address
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Address Line | 7886 RAGLAN DR NE
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City | WARREN
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State | OH
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Zip | 44484-1437
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Country | US
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Telephone | 330-550-5857
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.21482
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License Number State | OH
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