Provider Demographics
NPI:1144789512
Name:CURTIS, PENNY LYNN (LPN)
Entity Type:Individual
Prefix:MS
First Name:PENNY
Middle Name:LYNN
Last Name:CURTIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8440 BAMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48761-9715
Mailing Address - Country:US
Mailing Address - Phone:989-701-8869
Mailing Address - Fax:
Practice Address - Street 1:8440 BAMFIELD RD
Practice Address - Street 2:
Practice Address - City:SOUTH BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48761-9715
Practice Address - Country:US
Practice Address - Phone:989-701-8869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703082279164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse