Provider Demographics
NPI:1407189889
Name:PENNELL, REGINA LYNN (L)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:LYNN
Last Name:PENNELL
Suffix:
Gender:F
Credentials:L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 TAMMY CIR
Mailing Address - Street 2:
Mailing Address - City:NEW CONCORD
Mailing Address - State:OH
Mailing Address - Zip Code:43762-9684
Mailing Address - Country:US
Mailing Address - Phone:740-261-5013
Mailing Address - Fax:
Practice Address - Street 1:1000 TAMMY CIR
Practice Address - Street 2:
Practice Address - City:NEW CONCORD
Practice Address - State:OH
Practice Address - Zip Code:43762-9684
Practice Address - Country:US
Practice Address - Phone:740-261-5013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN131822 MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse