Look up the most recent NPI and PECOS records

Denise Pennicooke

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

9900 Bren Rd E, Minnetonka, MN 55343-9664

PECOS Enrollment

Based on the most recent information from CMS, provider Denise Pennicooke is legally eligible to order and refer claims for DME and PMD services only.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 10 days ago.

Profile Details

Provider ID
1962962530
Provider Type
Individual
Full Name
Pennicooke, Denise
Credential
NP

Gender
Female
Sole Proprietor
Yes
Enumeration Date
3/20/2019
Last Updated
9/22/2020

Contact Information

Practice Location

9900 Bren Rd E, Minnetonka, MN 55343-9664

(770) 324-6938

Unlisted Fax

Mailing Location

5680 Sterling Ct, Cumming, GA 30040-0579

(678) 333-4888

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363L00000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License RN227540 Georgia

Denise Pennicooke

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Soderstrom, Dawn E

Mcclintic, Kimberly Anne

Clapp, Angela M

Malark, Claire

Sanchez-Lopez, Teresa

Rokoszak, Lorraine

United Healthcare Services, Inc

Tucker, William Rowland

Johnson, Christie E

Smith, Sarah K.L.