Provider Demographics
NPI:1063736387
Name:PENNANT, NOVELETTE (LPN)
Entity type:Individual
Prefix:
First Name:NOVELETTE
Middle Name:
Last Name:PENNANT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:NOVELETTE
Other - Middle Name:
Other - Last Name:DOWNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:139 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-2515
Mailing Address - Country:US
Mailing Address - Phone:516-974-5692
Mailing Address - Fax:
Practice Address - Street 1:139 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-2515
Practice Address - Country:US
Practice Address - Phone:516-974-5692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262167164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse