Provider Demographics
NPI:1700025137
Name:NEAL, PENNY IRENE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:IRENE
Last Name:NEAL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:NAHCOTTA
Mailing Address - State:WA
Mailing Address - Zip Code:98637-0038
Mailing Address - Country:US
Mailing Address - Phone:360-642-4080
Mailing Address - Fax:
Practice Address - Street 1:120 FIRST AVENUE
Practice Address - Street 2:
Practice Address - City:ILWACO
Practice Address - State:WA
Practice Address - Zip Code:98624
Practice Address - Country:US
Practice Address - Phone:360-642-4080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018618174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0182654OtherWASHINGTON STATE DEPARTMENT OF LABOR AND INDUSTRIES