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NPI Code Detail

MEDICARE: MARY ELLEN PENWELL R.N.

MEDICARE: MARY ELLEN PENWELL R.N.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)RN187504LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174649669
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ELLEN PENWELL R.N.
Provider Business Mailing Address
First Line : 1000 S MERCER ST
Second Line : 4TH FLOOR
City : NEW CASTLE
State : PA
Zip : 16101-4672
Country : US
Telephone Number : 724-658-4688
Fax Number : 724-658-8810
Provider Business Practice Location Address
First Line : 1000 S MERCER ST
Second Line : 4TH FLOOR
City : NEW CASTLE
State : PA
Zip : 16101-4672
Country : US
Telephone Number : 724-658-4688
Fax Number : 724-658-8810
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2007
Last Update Date : 07/09/2007

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