Provider Demographics
NPI:1700399482
Name:PENNINGTON, LORETTA WANDA (PCA)
Entity Type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:WANDA
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:MRS
Other - First Name:LORETTA
Other - Middle Name:WANDA
Other - Last Name:FALLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:181 RABBIT RUN ROAD
Mailing Address - Street 2:
Mailing Address - City:HAMBLETON
Mailing Address - State:WV
Mailing Address - Zip Code:26269
Mailing Address - Country:US
Mailing Address - Phone:304-478-3881
Mailing Address - Fax:
Practice Address - Street 1:181 RABBIT RUN RD
Practice Address - Street 2:
Practice Address - City:HAMBLETON
Practice Address - State:WV
Practice Address - Zip Code:26269-8020
Practice Address - Country:US
Practice Address - Phone:304-478-3881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant