Individual
MRS. PENELOPE MASHBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
34.011231
OH
390200000X
Student in an Organized Health Care Education/Training Program
P12-00612
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0106134
—
OH
01
—
34011231
OHIO MEDICAL LICENSE
OH
Enumeration date
12/21/2009
Last updated
09/29/2014
Update your record
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