Provider Demographics
NPI:1598186447
Name:ALDRICH, PENNY M (ABC CERTIFIED)
Entity Type:Individual
Prefix:MS
First Name:PENNY
Middle Name:M
Last Name:ALDRICH
Suffix:
Gender:F
Credentials:ABC CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3572
Mailing Address - Country:US
Mailing Address - Phone:906-273-2090
Mailing Address - Fax:
Practice Address - Street 1:714 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3572
Practice Address - Country:US
Practice Address - Phone:906-273-2090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-19
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI46-4221980OtherEIN