Provider Demographics
NPI:1366966434
Name:REAMER, PENNY L (RN)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:L
Last Name:REAMER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17624 N 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-1935
Mailing Address - Country:US
Mailing Address - Phone:602-467-5910
Mailing Address - Fax:602-467-5980
Practice Address - Street 1:17624 N. 31ST AVE.
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053
Practice Address - Country:US
Practice Address - Phone:602-467-5910
Practice Address - Fax:602-467-5980
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN169859163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ86-6004178OtherDVUSD