Provider Demographics
NPI:1144425380
Name:PENNEY, JENNIFER E (ANP, FNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:PENNEY
Suffix:
Gender:F
Credentials:ANP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CONCOURSE WEST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4540
Mailing Address - Country:US
Mailing Address - Phone:207-873-1036
Mailing Address - Fax:207-873-1039
Practice Address - Street 1:16 W CONCOURSE
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6007
Practice Address - Country:US
Practice Address - Phone:207-873-1036
Practice Address - Fax:207-873-1039
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP081835363L00000X, 363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432627099Medicaid
ME001343302Medicare PIN
ME432627099Medicaid