Individual
MRS. PENNY LOU MINNOE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PRESIDENT
Contact information
Practice address
1597 CLARK STREET RD., C6, AUBURN, NY 13022
(315) 237-2814
(315) 253-3166
Mailing address
1540 GRAY RD, UNION SPRINGS, NY 13160-4100
(315) 237-2814
(315) 253-3166
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03056420
—
NY
01
—
300585673
TAX ID
NY
Enumeration date
05/18/2016
Last updated
05/18/2016
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