Provider Demographics
NPI:1477012045
Name:SLEEPWERX, LLC
Entity Type:Organization
Organization Name:SLEEPWERX, LLC
Other - Org Name:SLEEPWERX, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADULT/ACUTE CARE NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ANP-C, ACNP-BC
Authorized Official - Phone:480-571-8460
Mailing Address - Street 1:4320 E BROWN RD STE 104
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4081
Mailing Address - Country:US
Mailing Address - Phone:480-571-8460
Mailing Address - Fax:480-571-8461
Practice Address - Street 1:4320 E BROWN RD STE 104
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4081
Practice Address - Country:US
Practice Address - Phone:480-571-8460
Practice Address - Fax:480-571-8461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-13
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ584947Medicaid
AZ584947OtherMEDICAID