Provider Demographics
NPI:1023258589
Name:DAVIDSON, PENNI LEE
Entity type:Individual
Prefix:MRS
First Name:PENNI
Middle Name:LEE
Last Name:DAVIDSON
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 1:910 JOHN GEORGE LN
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:TX
Mailing Address - Zip Code:76266-7576
Mailing Address - Country:US
Mailing Address - Phone:940-458-3110
Mailing Address - Fax:
Practice Address - Street 1:910 JOHN GEORGE LN
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:TX
Practice Address - Zip Code:76266-7576
Practice Address - Country:US
Practice Address - Phone:940-458-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant