Individual
MARIAH JANE PENNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3650 URBAN DEPOT CT, WAYLAND, MI 49348-1008
(616) 888-0533
Mailing address
3650 URBAN DEPOT CT, WAYLAND, MI 49348-1008
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704387631
MI
363L00000X
Nurse Practitioner
Primary
4704387631
MI
Other
Enumeration date
10/03/2023
Last updated
01/13/2024
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