Provider Demographics
NPI:1760181960
Name:PENNINGTON, MARY RYAN DREW
Entity Type:Individual
Prefix:
First Name:MARY RYAN
Middle Name:DREW
Last Name:PENNINGTON
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 1:432 BAYBERRY POINTE DR NW APT H
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-4641
Mailing Address - Country:US
Mailing Address - Phone:248-310-7732
Mailing Address - Fax:
Practice Address - Street 1:432 BAYBERRY POINTE DR NW APT H
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-4641
Practice Address - Country:US
Practice Address - Phone:248-310-7732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program