=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770094252
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIA D RENNEISEN APRN, DNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2017
-----------------------------------------------------
Last Update Date | 11/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5303 HARRY HINES BLVD
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75390-7208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-650-5104
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5323 HARRY HINES BLVD NEUROLOGY/EPILEPSY
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75390-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-650-5104
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 076882-23
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------