Provider Demographics
NPI:1942599725
Name:HACKERT, PENNEY S (LPN)
Entity Type:Individual
Prefix:
First Name:PENNEY
Middle Name:S
Last Name:HACKERT
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 1:1100 DAVID DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-2753
Mailing Address - Country:US
Mailing Address - Phone:319-427-4882
Mailing Address - Fax:
Practice Address - Street 1:1100 DAVID DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-2753
Practice Address - Country:US
Practice Address - Phone:319-427-4882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP39884164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse