Provider Demographics
NPI:1649436783
Name:PENKALA, APRIL RENE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:APRIL
Middle Name:RENE
Last Name:PENKALA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:APRIL
Other - Middle Name:RENE
Other - Last Name:PINGRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1600 N RANDALL RD STE 400
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-7805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 N RANDALL RD STE 400
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-7805
Practice Address - Country:US
Practice Address - Phone:847-381-8899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003247363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR02834 FOR # 209118Medicare PIN
ILR02835 FOR #209119Medicare PIN