Individual
DANETTE PENGILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
GNP-C
Contact information
Practice address
310 N 10TH ST, BISMARCK, ND 58501-4516
(701) 530-7500
(701) 530-7484
Mailing address
310 N 10TH ST, BISMARCK, ND 58501-4516
(701) 530-7500
(701) 530-7484
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
R23780
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013016989
NPI
—
01
—
P00209023
RAILROAD MEDICARE
ND
Enumeration date
09/21/2006
Last updated
02/29/2008
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