Provider Demographics
NPI:1164914941
Name:NEPHEW, PENNY ELLEN (BS)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:ELLEN
Last Name:NEPHEW
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 DARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-2007
Mailing Address - Country:US
Mailing Address - Phone:765-362-2852
Mailing Address - Fax:765-362-2862
Practice Address - Street 1:1480 DARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-2007
Practice Address - Country:US
Practice Address - Phone:765-362-2852
Practice Address - Fax:765-362-2862
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator