Healthcare Provider Details

I. General information

NPI: 1750498986
Provider Name (Legal Business Name): TOBY ALLEN PENNER CRNA, MSN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 NW 11TH ST
HERMISTON OR
97838-6601
US

IV. Provider business mailing address

PO BOX 274
HERMISTON OR
97838-0274
US

V. Phone/Fax

Practice location:
  • Phone: 541-667-3406
  • Fax: 541-667-3420
Mailing address:
  • Phone: 541-564-4466
  • Fax: 541-564-4466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: