Provider Demographics
NPI:1033079397
Name:PENNOYER, ANITA MARIE
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:MARIE
Last Name:PENNOYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DOREEN
Other - Middle Name:ANN
Other - Last Name:ELSESSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DOREEN ELSESSER
Mailing Address - Street 1:1556 HONEYWELL RD
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-9555
Mailing Address - Country:US
Mailing Address - Phone:262-470-6930
Mailing Address - Fax:
Practice Address - Street 1:1556 HONEYWELL RD
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-9555
Practice Address - Country:US
Practice Address - Phone:262-470-6930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-17
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI92-2759306374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide