Provider Demographics
NPI:1215951462
Name:CHRISTMAN, PENNY MICHELLE (LPN)
Entity type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:MICHELLE
Last Name:CHRISTMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43713-1310
Mailing Address - Country:US
Mailing Address - Phone:740-425-3705
Mailing Address - Fax:740-425-3705
Practice Address - Street 1:218 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43713-1310
Practice Address - Country:US
Practice Address - Phone:740-425-3705
Practice Address - Fax:740-425-3705
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN105572164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPN105572OtherOHIO BOARD OF NURSING LIC
OH2331757Medicaid