Provider Demographics
NPI:1396196267
Name:MATHEWSON, PENNIE LYNN (CT)
Entity Type:Individual
Prefix:MRS
First Name:PENNIE
Middle Name:LYNN
Last Name:MATHEWSON
Suffix:
Gender:F
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 LAWRENCE RD NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-1102
Mailing Address - Country:US
Mailing Address - Phone:330-312-0433
Mailing Address - Fax:
Practice Address - Street 1:1309 LAWRENCE RD NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44705-1102
Practice Address - Country:US
Practice Address - Phone:330-312-0433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program