Provider Demographics
NPI:1720844475
Name:PENTON, DANIELLE (PMHNP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:PENTON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 NW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-8869
Mailing Address - Country:US
Mailing Address - Phone:515-401-8736
Mailing Address - Fax:
Practice Address - Street 1:1220 NE STATION XING STE 204
Practice Address - Street 2:
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-8013
Practice Address - Country:US
Practice Address - Phone:515-380-6516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG178308363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health