Provider Demographics
NPI:1598222127
Name:DRAZER, PENNY B (NP)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:B
Last Name:DRAZER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6249 RIVERCLIFF LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-3048
Mailing Address - Country:US
Mailing Address - Phone:937-475-3128
Mailing Address - Fax:
Practice Address - Street 1:540 LINCOLN PARK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-6403
Practice Address - Country:US
Practice Address - Phone:937-929-1117
Practice Address - Fax:937-298-4728
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH024367363LF0000X
OHAPRN.CNP.024367363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
F02191253OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION BOARD
OH024367OtherAPRN CERTIFIED NURSE PRACTITIONER