Provider Demographics
NPI:1760756886
Name:PENLAND, RODNEY SCOTT
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:SCOTT
Last Name:PENLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8218 S 77TH EAST AVE
Mailing Address - Street 2:APT 1080
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4069
Mailing Address - Country:US
Mailing Address - Phone:918-459-9932
Mailing Address - Fax:
Practice Address - Street 1:8218 S 77TH EAST AVE
Practice Address - Street 2:APT 1080
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4069
Practice Address - Country:US
Practice Address - Phone:918-459-9932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator