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General NPI Number Information
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NPI Number | 1871987552
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Entity Type | Individual
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Provider Name | PENNEY LOR
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Gender | Female
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Dates
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Enumeration Date | 03/20/2015
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Last Update Date | 03/20/2015
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Provider Practice Location Address
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Address Line | 6040 WATT AVE
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City | NORTH HIGHLANDS
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State | CA
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Zip | 95660-4212
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Country | US
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Telephone | 916-550-5450
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Fax |
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Provider Business Mailing Address
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Address Line | 7557 KILARNEY LN APT 292
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City | CITRUS HEIGHTS
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State | CA
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Zip | 95610-2968
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Country | US
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Telephone | 209-639-5070
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 821780
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License Number State | CA
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