Individual
MRS. PENNY IRENE NEAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
120 FIRST AVENUE, ILWACO, WA 98624
(360) 642-4080
Mailing address
PO BOX 38, NAHCOTTA, WA 98637-0038
(360) 642-4080
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00018618
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0182654
WASHINGTON STATE DEPARTMENT OF LABOR AND INDUSTRIES
WA
Enumeration date
02/09/2009
Last updated
02/09/2009
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