MEDICARE: AMANDA RAE BRENNER FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN.CNP.0036342	OH
2	363L00000X	Nurse Practitioner	APRN.CNP.0036342	OH

General Provider Information

NPI Number	:	1790532604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA RAE BRENNER FNP

Provider Business Mailing Address
First Line	:	6461 FRANK AVE NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-8412
Country	:	US
Telephone Number	:	330-433-7770
Fax Number	:	330-294-1720

Provider Business Practice Location Address
First Line	:	6461 FRANK AVE NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-8412
Country	:	US
Telephone Number	:	330-433-7770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2024
Last Update Date	:	04/17/2026

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