Provider Demographics
NPI:1356661870
Name:PENROSE, AMY BETH (LPN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:PENROSE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 HOLLANDER ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-6016
Mailing Address - Country:US
Mailing Address - Phone:740-641-6419
Mailing Address - Fax:
Practice Address - Street 1:700 HOLLANDER ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-6016
Practice Address - Country:US
Practice Address - Phone:740-641-6419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH111621164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse