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NPI Code Detail

MEDICARE: HOLLY DIANE PENNELL NP

MEDICARE: HOLLY DIANE PENNELL NP
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
1363L00000XNurse Practitioner209.020805IL
2363LF0000XFamily Nurse Practitioner277001909IL

General Provider Information

NPI Number : 1528690799
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY DIANE PENNELL NP
Provider Business Mailing Address
First Line : PO BOX 19248
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62794-9248
Country : US
Telephone Number : 217-528-7541
Fax Number :
Provider Business Practice Location Address
First Line : 1025 S 6TH ST
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62703-2499
Country : US
Telephone Number : 217-528-7541
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2020
Last Update Date : 03/02/2026

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