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General NPI Number Information
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NPI Number | 1962962530
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Entity Type | Individual
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Provider Name | DENISE PENNICOOKE NP
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Gender | Female
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Dates
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Enumeration Date | 03/20/2019
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Last Update Date | 09/22/2020
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Provider Practice Location Address
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Address Line | 9900 BREN RD E
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City | MINNETONKA
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State | MN
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Zip | 55343-9664
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Country | US
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Telephone | 770-324-6938
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Fax |
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Provider Business Mailing Address
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Address Line | 5680 STERLING CT
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City | CUMMING
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State | GA
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Zip | 30040-0579
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Country | US
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Telephone | 678-333-4888
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN227540
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License Number State | GA
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