Healthcare Provider Details

I. General information

NPI: 1972847382
Provider Name (Legal Business Name): PENNYMARIE ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2012
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4007 BELLAIRE BLVD SUITE GG
HOUSTON TX
77025-1166
US

IV. Provider business mailing address

3803 S CAULDER WAY
MISSOURI CITY TX
77459-6239
US

V. Phone/Fax

Practice location:
  • Phone: 281-362-5237
  • Fax:
Mailing address:
  • Phone: 281-723-3924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number613434
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number613434
License Number StateTX

VIII. Authorized Official

Name: PENNY WARNER
Title or Position: PRESIDENT/CEO
Credential: R.N.
Phone: 281-723-3924