Provider Demographics
NPI:1386838282
Name:SODERLUND, PENNY (RN)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:SODERLUND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:PENELOPE
Other - Middle Name:
Other - Last Name:SODERLUND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7001A EAST PKWY
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2501
Mailing Address - Country:US
Mailing Address - Phone:916-875-5000
Mailing Address - Fax:
Practice Address - Street 1:9333 TECH CENTER DR
Practice Address - Street 2:SUITE 800
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-2583
Practice Address - Country:US
Practice Address - Phone:916-875-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA229284163W00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163W00000XNursing Service ProvidersRegistered Nurse