Provider Demographics
NPI:1780005454
Name:ANDRESS, PENNY (RN, BSN)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:ANDRESS
Suffix:
Gender:F
Credentials:RN, BSN
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 1466
Mailing Address - Street 2:
Mailing Address - City:GOLDENDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98620-1466
Mailing Address - Country:US
Mailing Address - Phone:928-592-2115
Mailing Address - Fax:
Practice Address - Street 1:604 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GOLDENDALE
Practice Address - State:WA
Practice Address - Zip Code:98620-9248
Practice Address - Country:US
Practice Address - Phone:928-592-2115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00123445163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health