Provider Demographics
NPI:1275733495
Name:RENNER, JULIA A (CNP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:A
Last Name:RENNER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:A
Other - Last Name:DONATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:330-543-8050
Mailing Address - Fax:330-543-3835
Practice Address - Street 1:1 PERKINS SQ
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1063
Practice Address - Country:US
Practice Address - Phone:330-543-8050
Practice Address - Fax:330-543-3835
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.04777-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2592761Medicaid