Provider Demographics
NPI:1942328281
Name:PENNINGTON, DIANE M (DO)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 E. FRANKLIN ST.
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:KS
Mailing Address - Zip Code:67455
Mailing Address - Country:US
Mailing Address - Phone:785-524-4474
Mailing Address - Fax:785-524-5320
Practice Address - Street 1:313 E. FRANKLIN ST.
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:KS
Practice Address - Zip Code:67455
Practice Address - Country:US
Practice Address - Phone:785-524-4474
Practice Address - Fax:785-524-5320
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-26333207Q00000X
MO106532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine