Individual provider Active NPI

Julie B Brennan, CNP

  • Women's Health Nurse Practitioner
  • Youngstown, OH
National Provider Identifier
1447362850
Registry record updated Aug 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
APRN.CNP.01411 Issued in OH
Practice address
822 E Western Reserve Rd Ste 1
Youngstown, OH 44514-3359
Phone
(330) 953-3414
Fax
(330) 926-5855
NPI assigned
Aug 31, 2006
Last updated
Aug 23, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X APRN.CNP.01411 OH Primary
Obstetrics & Gynecology Nurse Practitioner 363LX0001X NP-01411 OH

Addresses

Primary practice location

822 E Western Reserve Rd Ste 1
Youngstown, OH 44514-3359

Mailing address

822 E Western Reserve Rd Ste 1
Youngstown, OH 44514-3359
Phone (330) 953-3414

Other identifiers 1

IdentifierTypeStateIssuer
0121952MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051025000666 OH Practitioner - Nurse Practitioner 4981621372 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP-01411OHMDObstetrics & Gynecology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Western Reserve Gynecology CurrentSince Jan 1, 2023 Accepting new patients
Triad Health Services, LLC PastSince Jan 1, 2023 Accepting new patients

Locations

800 E Western Reserve Rd
Youngstown, OH 44514
Phone (330) 629-9949

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1447362850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "822 E WESTERN RESERVE RD STE 1",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445143359",
            "telephone_number": "330-953-3414",
            "fax_number": "330-926-5855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "822 E WESTERN RESERVE RD STE 1",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445143359",
            "telephone_number": "330-953-3414",
            "fax_number": "330-926-5855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRENNAN",
        "first_name": "JULIE",
        "middle_name": "B",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "OH",
            "license": "APRN.CNP.01411",
            "primary": true
        },
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "OH",
            "license": "NP-01411",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0121952",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Youngstown, OH

Sources for this page

Verify at the official NPI Registry.