Individual
KATHLEEN ELIZABETH PENGELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
762 TRANSFER RD STE 21, SAINT PAUL, MN 55114-1489
(651) 659-2900
(651) 645-7307
Mailing address
762 TRANSFER RD STE 21, SAINT PAUL, MN 55114-1489
(651) 955-3397
(651) 645-7307
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
138239-0
MN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
6667
MN
Other
Enumeration date
01/15/2019
Last updated
08/15/2019
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