Provider Demographics
NPI:1831330323
Name:PENNEY, NATHAN (DPM)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:PENNEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16909 BURKE ST
Mailing Address - Street 2:STE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-2268
Mailing Address - Country:US
Mailing Address - Phone:402-333-8856
Mailing Address - Fax:402-333-8856
Practice Address - Street 1:16909 BURKE ST
Practice Address - Street 2:STE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-2268
Practice Address - Country:US
Practice Address - Phone:402-333-8856
Practice Address - Fax:402-333-3428
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003511213ES0103X
FLPO3391213ES0103X
NE364213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026641100Medicaid
NE47074840507Medicaid