Healthcare Provider Details

I. General information

NPI: 1306014923
Provider Name (Legal Business Name): CATHY L PENQUITE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2008
Last Update Date: 02/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 W GEORGE ST APT. C
ARCANUM OH
45304-1109
US

IV. Provider business mailing address

114 W GEORGE ST APT. C
ARCANUM OH
45304-1109
US

V. Phone/Fax

Practice location:
  • Phone: 937-760-0498
  • Fax:
Mailing address:
  • Phone: 937-760-0498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN069619
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: