Provider Demographics
NPI:1326149311
Name:PENNEY, CATHY LOUISE (RN)
Entity Type:Individual
Prefix:MS
First Name:CATHY
Middle Name:LOUISE
Last Name:PENNEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 975
Mailing Address - Street 2:
Mailing Address - City:MORONGO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92256
Mailing Address - Country:US
Mailing Address - Phone:760-363-6880
Mailing Address - Fax:
Practice Address - Street 1:68 615 PEREZ ROAD SUITE 6A
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234
Practice Address - Country:US
Practice Address - Phone:760-770-2221
Practice Address - Fax:760-770-2249
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA375091163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse