Provider Demographics
NPI:1336931815
Name:PENATE, RAYMAR
Entity type:Individual
Prefix:
First Name:RAYMAR
Middle Name:
Last Name:PENATE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-4950
Mailing Address - Country:US
Mailing Address - Phone:502-658-7607
Mailing Address - Fax:
Practice Address - Street 1:2727 W 2ND ST STE 215
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-4683
Practice Address - Country:US
Practice Address - Phone:402-991-4632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant