Provider Demographics
NPI:1447367198
Name:DIGIULIO, BRENDA (ARNP)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:DIGIULIO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14701 DETROIT AVE STE 522
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4109
Mailing Address - Country:US
Mailing Address - Phone:216-228-3232
Mailing Address - Fax:216-228-7507
Practice Address - Street 1:14701 DETROIT AVE STE 522
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4109
Practice Address - Country:US
Practice Address - Phone:216-228-3232
Practice Address - Fax:216-228-7507
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-10700363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1078324OtherARNP
KY789000866Medicaid
KY2026POtherARNP