Provider Demographics
NPI:1215368808
Name:HOURIHAN, PENNY (LPN)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:HOURIHAN
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 1:407 1/2 CAYUGA ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-1809
Mailing Address - Country:US
Mailing Address - Phone:315-218-5013
Mailing Address - Fax:
Practice Address - Street 1:407 1/2 CAYUGA ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-1809
Practice Address - Country:US
Practice Address - Phone:315-218-5013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293155164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse