Provider Demographics
NPI:1326757170
Name:PENN, GENELLE ESHON
Entity Type:Individual
Prefix:
First Name:GENELLE
Middle Name:ESHON
Last Name:PENN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17695 INDUSTRIAL FARM RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-9520
Mailing Address - Country:US
Mailing Address - Phone:661-391-7900
Mailing Address - Fax:
Practice Address - Street 1:17695 INDUSTRIAL FARM RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-9520
Practice Address - Country:US
Practice Address - Phone:661-391-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator