Provider Demographics
NPI:1568119790
Name:PENBERTHY, JULIA RAE (APRN)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:RAE
Last Name:PENBERTHY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25350 ROCKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-7110
Mailing Address - Country:US
Mailing Address - Phone:216-961-8804
Mailing Address - Fax:440-374-4965
Practice Address - Street 1:25350 ROCKSIDE RD STE 100
Practice Address - Street 2:
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44146-7111
Practice Address - Country:US
Practice Address - Phone:216-961-8804
Practice Address - Fax:440-374-4965
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0030332363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health