Healthcare Provider Details

I. General information

NPI: 1295534303
Provider Name (Legal Business Name): JENNA LORAINE PENNY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20611 EUCLID AVE
EUCLID OH
44117-1521
US

IV. Provider business mailing address

33 KENSINGTON AVE APT A10
PAINESVILLE OH
44077-3665
US

V. Phone/Fax

Practice location:
  • Phone: 216-859-2727
  • Fax:
Mailing address:
  • Phone: 440-622-1693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: