Provider Demographics
NPI:1124202072
Name:PENNIE, ANTHONY (LPN)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:PENNIE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 PENHURST ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-1518
Mailing Address - Country:US
Mailing Address - Phone:585-647-1882
Mailing Address - Fax:585-271-7948
Practice Address - Street 1:52 PENHURST ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14619-1518
Practice Address - Country:US
Practice Address - Phone:585-647-1882
Practice Address - Fax:585-271-7948
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY286751-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse