Provider Demographics
NPI:1891868048
Name:PENNELL, NANCY K (LADC 232)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:K
Last Name:PENNELL
Suffix:
Gender:F
Credentials:LADC 232
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 LAKE ST
Mailing Address - Street 2:BRYAN LGH INDEPENDENCE CENTER
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502
Mailing Address - Country:US
Mailing Address - Phone:402-481-5379
Mailing Address - Fax:402-481-5495
Practice Address - Street 1:1650 LAKE ST
Practice Address - Street 2:BRYAN LGH INDEPENDENCE CENTER
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502
Practice Address - Country:US
Practice Address - Phone:402-481-5379
Practice Address - Fax:402-481-5495
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47057655277Medicaid
NE47057655277Medicaid