Provider Demographics
NPI:1689145906
Name:PENNYMAN, JAMILA (NP)
Entity type:Individual
Prefix:
First Name:JAMILA
Middle Name:
Last Name:PENNYMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17645 HARBAUGH VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SABILLASVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21780-9616
Mailing Address - Country:US
Mailing Address - Phone:301-241-3629
Mailing Address - Fax:240-366-1851
Practice Address - Street 1:17645 HARBAUGH VALLEY RD
Practice Address - Street 2:
Practice Address - City:SABILLASVILLE
Practice Address - State:MD
Practice Address - Zip Code:21780-9616
Practice Address - Country:US
Practice Address - Phone:301-241-3629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-14
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR184220363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily