Individual
MR. CODY ALAN PENSKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
729 HAREFOOTE ST, HOLLAND, OH 43528-8566
(419) 410-5320
Mailing address
729 HAREFOOTE ST, HOLLAND, OH 43528-8566
(419) 410-5320
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
138468
OH
Other
Enumeration date
09/03/2011
Last updated
09/03/2011
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