MEDICARE: PENNY RUMSEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	470399238	MI

General Provider Information

NPI Number	:	1558748111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PENNY RUMSEY

Provider Business Mailing Address
First Line	:	113 WEST MICHIGAN AVE #1731
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201
Country	:	US
Telephone Number	:	941-277-3536
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 WEST MICHIGAN AVE #1731
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201
Country	:	US
Telephone Number	:	941-277-3536
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2015
Last Update Date	:	05/04/2015

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Directions to “ PENNY RUMSEY ” Practice Location

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