Provider Demographics
NPI:1871770578
Name:PENNYWELL, MICHELE R (RN)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:R
Last Name:PENNYWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MICHELE
Other - Middle Name:R
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 1375
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93716-1375
Mailing Address - Country:US
Mailing Address - Phone:559-777-0435
Mailing Address - Fax:559-412-8119
Practice Address - Street 1:895 S MARKS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-2200
Practice Address - Country:US
Practice Address - Phone:559-777-0435
Practice Address - Fax:559-412-8119
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA700492163WC0400X, 163WP0808X, 163W00000X, 163WC1500X, 163WG0000X, 163WH0200X, 163WM0705X, 163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation