Provider Demographics
NPI:1568222487
Name:EXNER, PENNY LEE
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:LEE
Last Name:EXNER
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 1:15565 S MIDWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-1117
Mailing Address - Country:US
Mailing Address - Phone:313-580-2619
Mailing Address - Fax:
Practice Address - Street 1:15565 S MIDWAY AVE
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1117
Practice Address - Country:US
Practice Address - Phone:313-580-2619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker