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NPI Code Detail

MEDICARE: MARTHA JEAN PENNINGTON RN

MEDICARE: MARTHA JEAN PENNINGTON RN
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
1163W00000XRegistered Nurse661207CA

General Provider Information

NPI Number : 1740768100
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTHA JEAN PENNINGTON RN
Provider Business Mailing Address
First Line : 1198 BOXELDER CIR
Second Line :
City : FOLSOM
State : CA
Zip : 95630-7669
Country : US
Telephone Number : 916-425-8394
Fax Number :
Provider Business Practice Location Address
First Line : 1435 RIVER PARK DR STE 200
Second Line :
City : SACRAMENTO
State : CA
Zip : 95815-4510
Country : US
Telephone Number : 916-286-7027
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2018
Last Update Date : 07/29/2018

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