Provider Demographics
NPI:1790457299
Name:CASSELL, PENNY ANN
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:ANN
Last Name:CASSELL
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 1:6520 N 7TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-1213
Mailing Address - Country:US
Mailing Address - Phone:480-681-0454
Mailing Address - Fax:480-681-0454
Practice Address - Street 1:6520 N 7TH ST STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-1213
Practice Address - Country:US
Practice Address - Phone:480-681-0454
Practice Address - Fax:480-681-0454
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-02
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP051258164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse