Healthcare Provider Details

I. General information

NPI: 1992845614
Provider Name (Legal Business Name): MICHELE PENMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5248 ROSE ST
SACRAMENTO CA
95838-1633
US

IV. Provider business mailing address

5503 DUNLAY DR
SACRAMENTO CA
95835-1523
US

V. Phone/Fax

Practice location:
  • Phone: 916-335-1185
  • Fax:
Mailing address:
  • Phone: 650-867-8908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number525193
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number525193
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: