Provider Demographics
NPI:1679634588
Name:PENINGTON, DOUGLAS R (NP)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:R
Last Name:PENINGTON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12717 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-3232
Mailing Address - Country:US
Mailing Address - Phone:402-292-6006
Mailing Address - Fax:402-292-7465
Practice Address - Street 1:12717 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-3232
Practice Address - Country:US
Practice Address - Phone:402-292-6006
Practice Address - Fax:402-292-7465
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110593363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q07354Medicare UPIN