Provider Demographics
NPI:1760821102
Name:PENNINGTON, SARA GENEVIEVE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:GENEVIEVE
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 PARKMAN WOOD RD
Mailing Address - Street 2:
Mailing Address - City:PUTNEY
Mailing Address - State:VT
Mailing Address - Zip Code:05346
Mailing Address - Country:US
Mailing Address - Phone:802-380-8952
Mailing Address - Fax:
Practice Address - Street 1:134 PARKMAN WOOD RD
Practice Address - Street 2:
Practice Address - City:PUTNEY
Practice Address - State:VT
Practice Address - Zip Code:05346
Practice Address - Country:US
Practice Address - Phone:802-380-8952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026-0029824163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant