Basic Information
| Provider Information | |||||||||
| NPI: | 1265453088 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OGDEN | ||||||||
| FirstName: | PENNY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1954 FORT UNION BLVD | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841216800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019939500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 950 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | BRIGHAM CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 843024724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005946399 | ||||||||
| FaxNumber: | 8017335618 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 225108-4406 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 87040324684121 A004 | 01 | UT | TRICARE | OTHER | PRA04451 | 01 | UT | MOLINA | OTHER | 2080245 | 01 | UT | UHC | OTHER | 107001918101 | 01 | UT | IHC | OTHER | QM0000076538 | 01 | UT | ALTIUS | OTHER | 340896 | 01 | UT | DMBA | OTHER | 870576522OG1 | 01 | UT | EDUCATOR'S | OTHER | 47568 | 01 | UT | PEHP | OTHER |