MEDICARE: GWEN PENNINGTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1225912355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWEN PENNINGTON

Provider Business Mailing Address
First Line	:	223 E 4TH ST
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-3000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 E 4TH ST
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-3000
Country	:	US
Telephone Number	:	360-417-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2025
Last Update Date	:	08/01/2025

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Directions to “ GWEN PENNINGTON ” Practice Location

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