Provider Demographics
NPI:1972830321
Name:PENKAVA, LAURA E (RRT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:E
Last Name:PENKAVA
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31792 BRYANT WAY SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-1854
Mailing Address - Country:US
Mailing Address - Phone:541-791-7724
Mailing Address - Fax:541-791-7400
Practice Address - Street 1:1135 DALE ST SE
Practice Address - Street 2:SUITE C
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-5392
Practice Address - Country:US
Practice Address - Phone:541-791-7724
Practice Address - Fax:541-791-7400
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRT-P-1004437227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered