Provider Demographics
NPI:1033513908
Name:HARGUESS, PENNY (NP)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:HARGUESS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57725 29 PALMS HWY
Mailing Address - Street 2:SUITE 401
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-3044
Mailing Address - Country:US
Mailing Address - Phone:760-228-1929
Mailing Address - Fax:760-228-9633
Practice Address - Street 1:57725 29 PALMS HWY
Practice Address - Street 2:SUITE 401
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3044
Practice Address - Country:US
Practice Address - Phone:760-228-1929
Practice Address - Fax:760-228-9633
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA515540163WH1000X
CA95001763363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice