Provider Demographics
NPI:1003184516
Name:GOOD, PENNY MARIE (CNA)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:MARIE
Last Name:GOOD
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LURAY
Mailing Address - State:VA
Mailing Address - Zip Code:22835-1027
Mailing Address - Country:US
Mailing Address - Phone:540-244-5509
Mailing Address - Fax:
Practice Address - Street 1:532 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LURAY
Practice Address - State:VA
Practice Address - Zip Code:22835-1027
Practice Address - Country:US
Practice Address - Phone:540-244-5509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401135973374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide