Individual
PATRICIA E PENNA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
14 TULIP GROVE DR, LAKE GROVE, NY 11755-1821
(631) 981-0704
Mailing address
14 TULIP GROVE DR, LAKE GROVE, NY 11755-1821
(631) 981-0704
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
371523-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01109897
—
NY
Enumeration date
12/19/2006
Last updated
07/09/2007
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