Provider Demographics
NPI:1285619890
Name:YENCHICK, PENNY E (CRNA)
Entity type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:E
Last Name:YENCHICK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:COAL TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:17866-9668
Mailing Address - Country:US
Mailing Address - Phone:570-644-4259
Mailing Address - Fax:570-644-1194
Practice Address - Street 1:4200 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:COAL TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:17866-9668
Practice Address - Country:US
Practice Address - Phone:570-644-4259
Practice Address - Fax:570-644-1194
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN291115L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS83126Medicare UPIN
PA546168QJ1Medicare ID - Type Unspecified