Provider Demographics
NPI:1669127189
Name:FOREMAN, PENNY LYNN
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:LYNN
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2632 MARION MARYSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-9200
Mailing Address - Country:US
Mailing Address - Phone:740-262-1650
Mailing Address - Fax:
Practice Address - Street 1:2632 MARION MARYSVILLE RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-9200
Practice Address - Country:US
Practice Address - Phone:740-262-1650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide