Provider Demographics
NPI:1568452852
Name:PENNINGTON, DEBRA (CRNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:973 S DARLA CT
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-8658
Mailing Address - Country:US
Mailing Address - Phone:847-688-5568
Mailing Address - Fax:
Practice Address - Street 1:1020 11TH AVE
Practice Address - Street 2:
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-3102
Practice Address - Country:US
Practice Address - Phone:847-688-5568
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP005810V363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health