Provider Demographics
NPI:1497996631
Name:FONDREN, PENNE NELSON (RN,MSN)
Entity Type:Individual
Prefix:MS
First Name:PENNE
Middle Name:NELSON
Last Name:FONDREN
Suffix:
Gender:F
Credentials:RN,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 DR. EDWARD HILLARD DR.
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35403
Mailing Address - Country:US
Mailing Address - Phone:205-759-1279
Mailing Address - Fax:205-344-4072
Practice Address - Street 1:1110 DR EDWARD HILLARD DR
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-7446
Practice Address - Country:US
Practice Address - Phone:205-759-1279
Practice Address - Fax:205-344-4072
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-065262163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse