Provider Demographics
NPI:1295593077
Name:PENNINGTON, AMY (RN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-3200
Mailing Address - Country:US
Mailing Address - Phone:541-910-0363
Mailing Address - Fax:
Practice Address - Street 1:1305 N WILLOW ST
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-3822
Practice Address - Country:US
Practice Address - Phone:541-663-3210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201607467RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse