Healthcare Provider Details

I. General information

NPI: 1356640668
Provider Name (Legal Business Name): LAUREN DANIELLE SNOW PENTICUFF APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2011
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9245 W HIGHWAY 80
NANCY KY
42544-8767
US

IV. Provider business mailing address

PO BOX 628
NANCY KY
42544-0628
US

V. Phone/Fax

Practice location:
  • Phone: 606-288-0013
  • Fax: 606-288-9600
Mailing address:
  • Phone: 606-288-0013
  • Fax: 606-288-9600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3006874
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: