Individual
PENNY L GNEITING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
1321 NE 99TH AVE, SUITE 200, PORTLAND, OR 97220-9436
(503) 215-4250
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10540
MN
363A00000X
Physician Assistant
1248
MN
363A00000X
Physician Assistant
Primary
PA159754
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
MN
Enumeration date
02/05/2009
Last updated
10/19/2020
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