Individual
JENNIFER ANNE PENNINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
4630 VISTULA RD, MISHAWAKA, IN 46544-4000
(574) 647-1900
(574) 254-7222
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02003207A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000533533
BCBS BMG SCHWARTZ-WIEKAMP
IN
05
—
200874950
—
IN
01
—
P00734479
RR MEDICARE
IN
Enumeration date
04/23/2007
Last updated
03/31/2021
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