MEDICARE: RODNESHA MARKALON PENSON LVN/LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	313803	TX

General Provider Information

NPI Number	:	1912860040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODNESHA MARKALON PENSON LVN/LPN

Provider Business Mailing Address
First Line	:	815 GREENVIEW DR
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75050-2439
Country	:	US
Telephone Number	:	469-251-1734
Fax Number	:	972-642-5183

Provider Business Practice Location Address
First Line	:	815 GREENVIEW DR
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75050-2439
Country	:	US
Telephone Number	:	469-251-1734
Fax Number	:	972-642-5183

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	12/05/2025

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