Provider Demographics
NPI:1013238351
Name:MCLEAN-NOWINSKI, PENNY MARIE (MSN-CNP)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:MARIE
Last Name:MCLEAN-NOWINSKI
Suffix:
Gender:F
Credentials:MSN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DAVOL SQ STE 400
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4760
Mailing Address - Country:US
Mailing Address - Phone:401-421-4000
Mailing Address - Fax:401-272-1456
Practice Address - Street 1:1445 WAMPANOAG TRL UNIT 205
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-1019
Practice Address - Country:US
Practice Address - Phone:401-434-0730
Practice Address - Fax:401-270-3439
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN01713363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1013238351Medicaid
OH11585-NPOtherMSN-CNP LICENSE