MEDICARE: MRS. PENNY DORENE KLEIN APN

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	363LW0102X	Women's Health Nurse Practitioner	26NN05831900	NJ

General Provider Information

NPI Number	:	1568667467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PENNY DORENE KLEIN APN

Provider Business Mailing Address
First Line	:	123 HOW LN
Second Line	:
City	:	NEW BRUNSWICK
State	:	NJ
Zip	:	08901-3653
Country	:	US
Telephone Number	:	732-745-8600
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 HOW LN
Second Line	:
City	:	NEW BRUNSWICK
State	:	NJ
Zip	:	08901-3653
Country	:	US
Telephone Number	:	732-745-8600
Fax Number	:

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

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	03/12/2014

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