Provider Demographics
NPI:1952992547
Name:DILORENZO, PENNY MARIE (CSFA)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:MARIE
Last Name:DILORENZO
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:694 SADDLE CIR
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31503-7930
Mailing Address - Country:US
Mailing Address - Phone:912-337-7789
Mailing Address - Fax:
Practice Address - Street 1:694 SADDLE CIR
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31503-7930
Practice Address - Country:US
Practice Address - Phone:912-337-7789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant