Provider Demographics
NPI:1063105963
Name:PENNELL, LOUIS H
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:H
Last Name:PENNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4436 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-1108
Mailing Address - Country:US
Mailing Address - Phone:330-416-7888
Mailing Address - Fax:
Practice Address - Street 1:4436 ELM AVE
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-1108
Practice Address - Country:US
Practice Address - Phone:330-416-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No171WH0202XOther Service ProvidersContractorHome Modifications