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NPI Profile for SUSAN K PENNYPACKER in GRAY, TN.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Family |
363LF0000X | 50 | Nurse Practitioner |
| NPI Number | 1194717157 |
|
| Status | Active | |
| Credentials | FNP C | |
| Entity | Individual | |
| Enumeration date | 08/16/2005 | |
| Last updated | 11/08/2011 - About 15 years ago | |
| Sole proprietor 1 | Yes | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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