Provider Demographics
NPI:1740768100
Name:PENNINGTON, MARTHA JEAN (RN)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:JEAN
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1198 BOXELDER CIR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-7669
Mailing Address - Country:US
Mailing Address - Phone:916-425-8394
Mailing Address - Fax:
Practice Address - Street 1:1435 RIVER PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4510
Practice Address - Country:US
Practice Address - Phone:916-286-7027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-29
Last Update Date:2018-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA661207163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse