Healthcare Provider Details

I. General information

NPI: 1033513908
Provider Name (Legal Business Name): PENNY HARGUESS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57725 29 PALMS HWY SUITE 401
YUCCA VALLEY CA
92284-3044
US

IV. Provider business mailing address

57725 29 PALMS HWY SUITE 401
YUCCA VALLEY CA
92284-3044
US

V. Phone/Fax

Practice location:
  • Phone: 760-228-1929
  • Fax: 760-228-9633
Mailing address:
  • Phone: 760-228-1929
  • Fax: 760-228-9633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number515540
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95001763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: