Provider Demographics
NPI:1962428029
Name:PENN, JANICE M
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:M
Last Name:PENN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 MAPLE LN STE 1
Mailing Address - Street 2:ESSENTIA HEALTH ASHLAND CLINIC
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-3610
Mailing Address - Country:US
Mailing Address - Phone:715-685-7500
Mailing Address - Fax:715-682-2481
Practice Address - Street 1:1615 MAPLE LN STE 1
Practice Address - Street 2:ESSENTIA HEALTH ASHLAND CLINIC
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-3610
Practice Address - Country:US
Practice Address - Phone:715-685-7500
Practice Address - Fax:715-682-2481
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54647-030363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN131218900Medicaid
WI43935500Medicaid
P25242Medicare UPIN
MN131218900Medicaid