Provider Demographics
NPI:1609001866
Name:PENN, KATHERINE LORAINE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LORAINE
Last Name:PENN
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 1:2242 LIGHT ST
Mailing Address - Street 2:APT 2
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-6133
Mailing Address - Country:US
Mailing Address - Phone:347-449-5481
Mailing Address - Fax:
Practice Address - Street 1:2242 LIGHT ST
Practice Address - Street 2:APT 2
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-6133
Practice Address - Country:US
Practice Address - Phone:347-449-5481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY418648-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse