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General NPI Number Information
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NPI Number | 1518448307
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Entity Type | Individual
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Provider Name | MICHELLE RUTH PENNO FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/28/2018
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Last Update Date | 02/21/2019
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Provider Practice Location Address
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Address Line | 13430 N SCOTTSDALE RD STE 200
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-4058
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Country | US
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Telephone | 888-407-7928
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Fax |
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Provider Business Mailing Address
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Address Line | 6677 W THUNDERBIRD RD STE C142
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City | GLENDALE
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State | AZ
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Zip | 85306-3760
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Country | US
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Telephone | 480-963-1853
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Fax | 602-973-0978
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP11242
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License Number State | AZ
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