Provider Demographics
NPI:1811786486
Name:MINARD, PENNY SUE (RN)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:SUE
Last Name:MINARD
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39861 ROAD 721
Mailing Address - Street 2:
Mailing Address - City:BARTLEY
Mailing Address - State:NE
Mailing Address - Zip Code:69020-6131
Mailing Address - Country:US
Mailing Address - Phone:308-340-8785
Mailing Address - Fax:
Practice Address - Street 1:424 N 6TH ST
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:NE
Practice Address - Zip Code:69034-3424
Practice Address - Country:US
Practice Address - Phone:308-340-8785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE40212163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse