Provider Demographics
NPI:1073855136
Name:LHAMO, PENPA (RN)
Entity Type:Individual
Prefix:MRS
First Name:PENPA
Middle Name:
Last Name:LHAMO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 40TH ST APT 5J
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-4023
Mailing Address - Country:US
Mailing Address - Phone:191-720-7807
Mailing Address - Fax:
Practice Address - Street 1:4720 40TH ST APT 5J
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-4023
Practice Address - Country:US
Practice Address - Phone:191-720-7807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY628276163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYSJ21654CMedicaid