Provider Demographics
NPI:1568181428
Name:PENNYPACKER, STEPHANIE JUNE (MS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JUNE
Last Name:PENNYPACKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2165 TUCKER ST APT 2318
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-0196
Mailing Address - Country:US
Mailing Address - Phone:940-393-3728
Mailing Address - Fax:
Practice Address - Street 1:2165 TUCKER ST APT 2318
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-0196
Practice Address - Country:US
Practice Address - Phone:940-393-3728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist