Healthcare Provider Details

I. General information

NPI: 1740483825
Provider Name (Legal Business Name): CAROL LEE PENNELL RNC, IBCLC,CCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 04/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 SALEM TPKE
NORWICH CT
06360-6407
US

IV. Provider business mailing address

82 SALEM TPKE
NORWICH CT
06360-6407
US

V. Phone/Fax

Practice location:
  • Phone: 860-889-2323
  • Fax: 860-859-1622
Mailing address:
  • Phone: 860-889-2323
  • Fax: 860-859-1622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberE51898
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: