Provider Demographics
NPI:1639159106
Name:MONEYPENNY, MARTHA FAY (NP)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:FAY
Last Name:MONEYPENNY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 N CENTRAL AVE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2902
Mailing Address - Country:US
Mailing Address - Phone:602-718-3050
Mailing Address - Fax:602-943-4359
Practice Address - Street 1:3003 N CENTRAL AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2902
Practice Address - Country:US
Practice Address - Phone:602-718-3050
Practice Address - Fax:602-943-4359
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN065712363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ369430Medicaid
AZ369430Medicaid
AZS48018Medicare UPIN