Provider Demographics
NPI:1659150407
Name:PENNING, REBECCA M (APRN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:PENNING
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 E ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-3103
Mailing Address - Country:US
Mailing Address - Phone:507-676-2850
Mailing Address - Fax:
Practice Address - Street 1:2014 JEFFERSON RD STE C
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-3251
Practice Address - Country:US
Practice Address - Phone:507-646-6700
Practice Address - Fax:507-646-6701
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN10803363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner