Provider Demographics
NPI:1689400665
Name:PENWELL, JEANNE
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:
Last Name:PENWELL
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 1:1659 MAYFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44509-2838
Mailing Address - Country:US
Mailing Address - Phone:330-397-9459
Mailing Address - Fax:
Practice Address - Street 1:1659 MAYFIELD AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509-2838
Practice Address - Country:US
Practice Address - Phone:330-397-9459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide