Individual
MISS JESSICA LEIGH PENNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
23 WILDWOOD DR, PRESCOTT, AZ 86305-5094
(928) 778-2734
Mailing address
23 WILDWOOD DR, PRESCOTT, AZ 86305-5094
(928) 778-2734
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN158856
AZ
Other
Enumeration date
10/22/2009
Last updated
10/22/2009
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