Individual
HEATHER MICHELLE PENNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5050 NE HOYT ST, SUITE 454, PORTLAND, OR 97213-2991
(503) 215-6405
(503) 215-6409
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
LL17601
OR
207Q00000X
Family Medicine Physician
Primary
MD29200
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500615947
—
OR
01
—
P00893296
RR MEDICARE
OR
Enumeration date
08/22/2008
Last updated
02/10/2022
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