Provider Demographics
NPI:1689700064
Name:PENWELL, LORETTA MAE (LPN)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:MAE
Last Name:PENWELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 NORTH MOUNTAIN STREET
Mailing Address - Street 2:BOX 374
Mailing Address - City:BAINBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:45612
Mailing Address - Country:US
Mailing Address - Phone:740-634-2381
Mailing Address - Fax:
Practice Address - Street 1:212 NORTH MOUNTAIN STREET
Practice Address - Street 2:BOX 374
Practice Address - City:BAINBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:45612
Practice Address - Country:US
Practice Address - Phone:740-634-2381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN080367164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse