Individual
PENNY ANN DEEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
153 LEO LN, WASHINGTON, WV 26181-8466
(304) 588-3036
Mailing address
153 LEO LN, WASHINGTON, WV 26181-8466
(304) 588-3036
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
22807
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
630435
WORKMANS COMP
WV
Enumeration date
10/27/2022
Last updated
10/27/2022
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