MEDICARE: EMILY PENNY AGPCNP-BC

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
1	363LA2200X	Adult Health Nurse Practitioner	224277	NC

General Provider Information

NPI Number	:	1356762488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY PENNY AGPCNP-BC

Provider Business Mailing Address
First Line	:	UNIVERSITY OF NORTH CAROLINA AT CHAPEL HL
Second Line	:	CB #7206
City	:	CHAPEL HILL
State	:	NC
Zip	:	27599-7206
Country	:	US
Telephone Number	:	919-966-3005
Fax Number	:	966-843-3850

Provider Business Practice Location Address
First Line	:	UNIVERSITY OF NORTH CAROLINA AT CHAPEL HL
Second Line	:	CB #7206
City	:	CHAPEL HILL
State	:	NC
Zip	:	27599-7206
Country	:	US
Telephone Number	:	919-966-3005
Fax Number	:	966-843-3850

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2013
Last Update Date	:	12/16/2013

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