Provider Demographics
NPI:1407096449
Name:PENNINGTON, JANICE MORTIMER (NP)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:MORTIMER
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:908 NIAGARA FALLS BLVD
Mailing Address - Street 2:STE 208
Mailing Address - City:N TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2019
Mailing Address - Country:US
Mailing Address - Phone:716-692-3302
Mailing Address - Fax:716-213-0935
Practice Address - Street 1:3 GATES CIR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1120
Practice Address - Country:US
Practice Address - Phone:716-887-4798
Practice Address - Fax:716-887-4941
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY305058363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner