Healthcare Provider Details

I. General information

NPI: 1558081109
Provider Name (Legal Business Name): PENELOPE ANNE AUTEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/11/2025
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

53254 CHESHIRE DR
SHELBY TOWNSHIP MI
48316-2711
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-2323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number839380
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: