Provider Demographics
NPI:1609144138
Name:NORMAN, PENNY (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:
Last Name:NORMAN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 S CANTLE CIR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-2123
Mailing Address - Country:US
Mailing Address - Phone:435-703-9227
Mailing Address - Fax:
Practice Address - Street 1:121 W TABERNACLE ST
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3338
Practice Address - Country:US
Practice Address - Phone:435-673-3553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2204553102163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool