Provider Demographics
NPI:1629542691
Name:PENNETTI, JULIE LAUREN (ANP-C, RN, CCRN)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:LAUREN
Last Name:PENNETTI
Suffix:
Gender:F
Credentials:ANP-C, RN, CCRN
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Other - First Name:
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Mailing Address - Street 1:340 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3213
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:340 W PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3213
Practice Address - Country:US
Practice Address - Phone:855-605-4837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY308809363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health