Active NPI
Penni Lane Exton, RN
- Wound Care Registered Nurse
- Momence, IL
National Provider Identifier
1417628249
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Wound Care Registered Nurse
- License
- 04148062
- Practice address
- 424 N Locust St
Momence, IL 60954-1236 - Phone
- (219) 973-8716
- NPI assigned
- Sep 22, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Wound Care Registered Nurse | 163WW0000X | 04148062 | IL | Primary |
Addresses
Primary practice location
424 N Locust St
Momence, IL 60954-1236
Mailing address
424 N Locust St
Momence, IL 60954-1236
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04148062 | IL | MD | Wound Care Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632268800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632268800000",
"number": "1417628249",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "424 N LOCUST ST",
"city": "MOMENCE",
"state": "IL",
"postal_code": "609541236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "424 N LOCUST ST",
"city": "MOMENCE",
"state": "IL",
"postal_code": "609541236",
"telephone_number": "219-973-8716"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EXTON",
"first_name": "PENNI",
"middle_name": "LANE",
"name_prefix": "Mrs.",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-09-22",
"last_updated": "2021-09-22",
"certification_date": "2021-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "163WW0000X",
"taxonomy_group": "",
"desc": "Registered Nurse, Wound Care",
"state": "IL",
"license": "04148062",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Momence, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.