Provider Demographics
NPI:1760817381
Name:FORD, PENNY JAYNE (LPN)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:JAYNE
Last Name:FORD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 CLEARVIEW ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-2212
Mailing Address - Country:US
Mailing Address - Phone:570-785-2624
Mailing Address - Fax:
Practice Address - Street 1:238 DELEWARE STREET
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:PA
Practice Address - Zip Code:18421
Practice Address - Country:US
Practice Address - Phone:570-785-2624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PALPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse