Provider Demographics
NPI:1265627715
Name:RIMMER, PENNY H
Entity type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:H
Last Name:RIMMER
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 1:4722 HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-6222
Mailing Address - Country:US
Mailing Address - Phone:252-247-7830
Mailing Address - Fax:252-247-7830
Practice Address - Street 1:4722 HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-6222
Practice Address - Country:US
Practice Address - Phone:252-247-7830
Practice Address - Fax:252-247-7830
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-016-0083747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802361Medicaid