Individual
MARITTA A PENEGOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-BC
Contact information
Practice address
24 JOLIET ST, SUITE 401, DYER, IN 46311-1705
(219) 865-0893
(219) 865-3599
Mailing address
3615 PARK DR, SUITE 203, OLYMPIA FIELDS, IL 60461-1186
(708) 748-9800
(708) 748-9807
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
70000040A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00150268
RAILROAD MEDICARE
—
Enumeration date
08/31/2006
Last updated
09/27/2007
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