Healthcare Provider Details

I. General information

NPI: 1518203686
Provider Name (Legal Business Name): PENNY NELEEN LAMASCUS MSN WHNP-BC / ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 S LIMESTONE ST
SPRINGFIELD OH
45505-3058
US

IV. Provider business mailing address

1416 W 1ST ST
SPRINGFIELD OH
45504-1923
US

V. Phone/Fax

Practice location:
  • Phone: 937-325-1010
  • Fax: 937-325-5144
Mailing address:
  • Phone: 937-322-1700
  • Fax: 937-398-5189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberCOA.14126-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: