Provider Demographics
NPI:1609475110
Name:PENGAL, JULIE
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:PENGAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4619 MUIRWOOD PL
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-2181
Mailing Address - Country:US
Mailing Address - Phone:330-256-1035
Mailing Address - Fax:
Practice Address - Street 1:4619 MUIRWOOD PL
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-2181
Practice Address - Country:US
Practice Address - Phone:330-256-1035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty