Provider Demographics
NPI:1508006115
Name:PENTER, SANDEE D
Entity Type:Individual
Prefix:MRS
First Name:SANDEE
Middle Name:D
Last Name:PENTER
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 1:805 NE RESERVOIR LN
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OR
Mailing Address - Zip Code:97391-1335
Mailing Address - Country:US
Mailing Address - Phone:541-336-2254
Mailing Address - Fax:541-336-1803
Practice Address - Street 1:805 NE RESERVOIR LN
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OR
Practice Address - Zip Code:97391-1335
Practice Address - Country:US
Practice Address - Phone:541-336-2254
Practice Address - Fax:541-336-1803
Is Sole Proprietor?:No
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR93-0698327OtherPRIVATE NON PROFIT