Individual
NINA DRUCILLA PENNEWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
6011 SHALLOWFORD RD, CHATTANOOGA, TN 37421
(800) 632-6074
(866) 341-7509
Mailing address
PO BOX 10414, LARGO, FL 33773
(800) 632-6074
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
P0000002028
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3981285
—
TN
01
—
4090448
BCBS W PARADIGM
TN
01
—
P00182194
RR MEDICARE W PARADIGM
TN
Enumeration date
09/19/2006
Last updated
08/25/2007
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