Individual
HEATHER W PENNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1 AUDUBON PLAZA DR, LOUISVILLE, KY 40217-1318
(502) 636-7160
Mailing address
1010 LODGE HILL RD, LOUISVILLE, KY 40223-5509
(502) 648-2230
(502) 244-4967
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3979A
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
74005968
—
KY
Enumeration date
10/06/2006
Last updated
02/14/2013
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