Provider Demographics
NPI:1164703179
Name:PENNA, CHRISTINE E (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:E
Last Name:PENNA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:E
Other - Last Name:MULLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14470-1115
Mailing Address - Country:US
Mailing Address - Phone:585-638-5970
Mailing Address - Fax:
Practice Address - Street 1:15 WEST AVE
Practice Address - Street 2:
Practice Address - City:HOLLEY
Practice Address - State:NY
Practice Address - Zip Code:14470-1115
Practice Address - Country:US
Practice Address - Phone:585-638-5970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-03
Last Update Date:2011-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292575-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse