Individual
PENNY EDGERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1540 TRINITY PL, MISHAWAKA, IN 46545-5006
(574) 272-9000
Mailing address
46965 PROSPECT DR, DECATUR, MI 49045-9011
(269) 591-1557
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704339733
MI
Other
Enumeration date
04/07/2023
Last updated
04/07/2023
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