Provider Demographics
NPI:1922549302
Name:PENWELL, ABBY MARIE
Entity Type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:MARIE
Last Name:PENWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ABBY
Other - Middle Name:MARIE
Other - Last Name:PENWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:628 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45123-1326
Mailing Address - Country:US
Mailing Address - Phone:937-509-1744
Mailing Address - Fax:
Practice Address - Street 1:628 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:OH
Practice Address - Zip Code:45123-1326
Practice Address - Country:US
Practice Address - Phone:937-509-1744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401657040614376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide