Provider Demographics
NPI:1114112414
Name:PHILIPPI, PENNY L (CSFA)
Entity Type:Individual
Prefix:MS
First Name:PENNY
Middle Name:L
Last Name:PHILIPPI
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 S MILL AVE STE 168
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-3674
Mailing Address - Country:US
Mailing Address - Phone:602-438-0041
Mailing Address - Fax:
Practice Address - Street 1:3116 S MILL AVE STE 168
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-3674
Practice Address - Country:US
Practice Address - Phone:602-438-0041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
F01204246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant