Provider Demographics
NPI:1679226542
Name:PENNEKAMP, MORGAN ANDREA (APRN)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:ANDREA
Last Name:PENNEKAMP
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 1:6700 HOME CITY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45233-1119
Mailing Address - Country:US
Mailing Address - Phone:513-363-5170
Mailing Address - Fax:
Practice Address - Street 1:6700 HOME CITY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45233-1119
Practice Address - Country:US
Practice Address - Phone:513-363-5170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0030622363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAPRN.CNP.0030622OtherOHIO BOARD OF NURSING
KY1157049OtherKENTUCKY BOARD OF NURSING
OH405093OtherOHIO BOARD OF NURSING