Provider Demographics
NPI:1255995544
Name:PENANO, KAREN UY (CRNP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:UY
Last Name:PENANO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:MANGUBAT
Other - Last Name:UY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:8975 UPBEAT WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-5535
Mailing Address - Country:US
Mailing Address - Phone:410-736-9281
Mailing Address - Fax:
Practice Address - Street 1:2315 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2201
Practice Address - Country:US
Practice Address - Phone:916-703-4496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR188364363LA2100X
CA95015190363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care