Provider Demographics
NPI:1700901279
Name:SUDDOCK, PENNY L
Entity Type:Individual
Prefix:MS
First Name:PENNY
Middle Name:L
Last Name:SUDDOCK
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 1:1507 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-3256
Mailing Address - Country:US
Mailing Address - Phone:620-423-1547
Mailing Address - Fax:
Practice Address - Street 1:1507 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-3256
Practice Address - Country:US
Practice Address - Phone:620-423-1547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle