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General NPI Number Information
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NPI Number | 1154650117
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Entity Type | Individual
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Provider Name | PENELOPE MASHBURN D.O.
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Gender | Female
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Dates
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Enumeration Date | 12/21/2009
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Last Update Date | 09/29/2014
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Provider Practice Location Address
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Address Line | 27 ST. LAWRENCE DR. SUITE203
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City | TIFFIN
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State | OH
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Zip | 44883
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Country | US
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Telephone | 305-575-9978
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Fax | 419-455-8564
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Provider Business Mailing Address
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Address Line | 2200 JEFFERSON AVE 4TH FLOOR
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City | TOLEDO
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State | OH
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Zip | 43604-7101
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 34.011231
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | P12-00612
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License Number State | NJ
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