Provider Demographics
NPI:1336454149
Name:PENNADO, VENICE CORETTA (LPN)
Entity Type:Individual
Prefix:
First Name:VENICE
Middle Name:CORETTA
Last Name:PENNADO
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 1:3512 GRACE AVE
Mailing Address - Street 2:PH
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-5817
Mailing Address - Country:US
Mailing Address - Phone:347-981-1526
Mailing Address - Fax:
Practice Address - Street 1:4377 BRONX BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-1397
Practice Address - Country:US
Practice Address - Phone:718-519-7672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270240-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse