Provider Demographics
NPI:1487985305
Name:KOLLEN, PENNY L (RN)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:L
Last Name:KOLLEN
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 1:363 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2309
Mailing Address - Country:US
Mailing Address - Phone:541-465-3966
Mailing Address - Fax:541-465-3967
Practice Address - Street 1:780 NW GARDEN VALLEY BLVD STE 46B
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-6528
Practice Address - Country:US
Practice Address - Phone:541-673-1599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR084060835RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse