Healthcare Provider Details

I. General information

NPI: 1558748111
Provider Name (Legal Business Name): PENNY RUMSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2015
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 WEST MICHIGAN AVE #1731
JACKSON MI
49201
US

IV. Provider business mailing address

113 WEST MICHIGAN AVE #1731
JACKSON MI
49201
US

V. Phone/Fax

Practice location:
  • Phone: 941-277-3536
  • Fax:
Mailing address:
  • Phone: 941-277-3536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number470399238
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: