Provider Demographics
NPI:1447850078
Name:PENWELL, HEATHER LYNN (BSN, RN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:PENWELL
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 CABIN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PIKETON
Mailing Address - State:OH
Mailing Address - Zip Code:45661-8097
Mailing Address - Country:US
Mailing Address - Phone:740-941-8165
Mailing Address - Fax:
Practice Address - Street 1:185 CABIN CREEK RD
Practice Address - Street 2:
Practice Address - City:PIKETON
Practice Address - State:OH
Practice Address - Zip Code:45661-8097
Practice Address - Country:US
Practice Address - Phone:740-941-8165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.417076163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse