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General NPI Number Information
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NPI Number | 1760181960
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Entity Type | Individual
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Provider Name | MARY RYAN DREW PENNINGTON
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Gender | Female
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Dates
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Enumeration Date | 02/27/2023
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Last Update Date | 02/27/2023
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Provider Practice Location Address
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Address Line | 432 BAYBERRY POINTE DR NW APT H
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City | GRAND RAPIDS
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State | MI
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Zip | 49534-4641
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Country | US
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Telephone | 248-310-7732
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Fax |
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Provider Business Mailing Address
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Address Line | 432 BAYBERRY POINTE DR NW APT H
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City | GRAND RAPIDS
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State | MI
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Zip | 49534-4641
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Country | US
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Telephone | 248-310-7732
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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