Provider Demographics
NPI:1417239658
Name:OILER, PENNY MICHELLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:MICHELLE
Last Name:OILER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:PENNY
Other - Middle Name:MICHELLE
Other - Last Name:DOTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2390 STATE ROUTE 602
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:OH
Mailing Address - Zip Code:44827-9711
Mailing Address - Country:US
Mailing Address - Phone:419-569-1478
Mailing Address - Fax:
Practice Address - Street 1:2390 STATE ROUTE 602
Practice Address - Street 2:
Practice Address - City:CRESTLINE
Practice Address - State:OH
Practice Address - Zip Code:44827-9711
Practice Address - Country:US
Practice Address - Phone:419-569-1478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN287658163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse