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General NPI Number Information
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NPI Number | 1104260413
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Entity Type | Individual
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Provider Name | MARY ELIZABETH PENKALA CNS
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Gender | Female
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Dates
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Enumeration Date | 04/18/2013
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 6847 N CHESTNUT ST STE 115
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City | RAVENNA
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State | OH
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Zip | 44266-3929
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Country | US
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Telephone | 330-297-6055
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Fax |
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Provider Business Mailing Address
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Address Line | 6847 N CHESTNUT ST STE 115
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City | RAVENNA
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State | OH
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Zip | 44266-3929
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Country | US
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Telephone | 330-297-6055
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Fax | 330-297-4918
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number | APRN.CNS.01044
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License Number State | OH
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