Individual
PENNY ATTAWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
1404 N 5TH STREET, VANDALIA, IL 62471
(618) 283-2000
(618) 283-2002
Mailing address
1404 N 5TH STREET, VANDALIA, IL 62471
(618) 283-2000
(618) 283-2002
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209001693
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
371352296003
—
IL
01
—
L040233
TRICARE INS
—
Enumeration date
09/27/2006
Last updated
12/20/2016
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