Provider Demographics
NPI:1386196418
Name:PENWELL, CARLYN (DNP, CNM)
Entity Type:Individual
Prefix:DR
First Name:CARLYN
Middle Name:
Last Name:PENWELL
Suffix:
Gender:F
Credentials:DNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8316 ARLINGTON BLVD STE 610
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-5204
Mailing Address - Country:US
Mailing Address - Phone:703-698-2066
Mailing Address - Fax:
Practice Address - Street 1:8316 ARLINGTON BLVD STE 610
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-5204
Practice Address - Country:US
Practice Address - Phone:703-698-2066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNM0322367A00000X
VA0024180405367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife