Provider Demographics
NPI:1467465484
Name:PENNINGTON, SUSAN (CRNFA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 W PARKER RD
Mailing Address - Street 2:SUITE 430
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8171
Mailing Address - Country:US
Mailing Address - Phone:972-981-8440
Mailing Address - Fax:972-981-8268
Practice Address - Street 1:6020 W PARKER RD
Practice Address - Street 2:SUITE 430
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8171
Practice Address - Country:US
Practice Address - Phone:972-981-8440
Practice Address - Fax:972-981-8268
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX539116163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant