Individual
RUTH PENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
14555 W NATIONAL AVE, NEW BERLIN, WI 53151-4494
(262) 693-4312
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
8281-23
WI
363AM0700X
Medical Physician Assistant
Primary
085007424
IL
363AM0700X
Medical Physician Assistant
PA21981
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100317341
—
WI
Enumeration date
11/07/2011
Last updated
06/17/2025
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