Individual
MARY M PENA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
6019 WALNUT GROVE RD, MEMPHIS, TN 38120-2113
(901) 226-5000
Mailing address
300 MAIN ST, LEWISTON, ME 04240-7027
(901) 682-2872
(901) 682-9316
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
15607
TN
367500000X
Certified Registered Nurse Anesthetist
RN157932
AR
367500000X
Certified Registered Nurse Anesthetist
RNA183034
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
180258001
—
AR
Enumeration date
07/30/2009
Last updated
10/07/2022
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