Provider Demographics
NPI:1528182094
Name:PANNELL, KIMBERLY LORRAINE (LPN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LORRAINE
Last Name:PANNELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5183 ALGEAN DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8459
Mailing Address - Country:US
Mailing Address - Phone:614-833-2784
Mailing Address - Fax:
Practice Address - Street 1:5183 ALGEAN DR
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-8459
Practice Address - Country:US
Practice Address - Phone:614-833-2784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 092937164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2355302Medicaid