Provider Demographics
NPI:1841914991
Name:GARBER, PENNY SUE (RN BSN ADMINISTRATOR)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:SUE
Last Name:GARBER
Suffix:
Gender:F
Credentials:RN BSN ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26325 S. HWY 125
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AFTON
Mailing Address - State:OK
Mailing Address - Zip Code:74331
Mailing Address - Country:US
Mailing Address - Phone:918-257-7161
Mailing Address - Fax:918-257-7162
Practice Address - Street 1:26325 S. HWY 125
Practice Address - Street 2:SUITE 101
Practice Address - City:AFTON
Practice Address - State:OK
Practice Address - Zip Code:74331
Practice Address - Country:US
Practice Address - Phone:918-257-7161
Practice Address - Fax:918-257-7162
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKHC8065253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care