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General NPI Number Information
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NPI Number | 1366265274
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Entity Type | Individual
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Provider Name | TONYIA KATRIC PENDER CEO
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Gender | Female
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 10555 S CRATER RD
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City | SOUTH PRINCE GEORGE
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State | VA
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Zip | 23805-7333
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Country | US
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Telephone | 804-919-2897
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Fax |
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Provider Business Mailing Address
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Address Line | 23308 PHEASANT CT
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City | NORTH DINWIDDIE
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State | VA
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Zip | 23803-8380
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Country | US
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Telephone | 804-919-2897
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 0002064084
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License Number State | VA
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