Basic Information
| Provider Information | |||||||||
| NPI: | 1528238672 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PENTELBURY | ||||||||
| FirstName: | LAURENE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 TILBURY DRIVE | ||||||||
| Address2: | |||||||||
| City: | KEARNY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203635573 | ||||||||
| FaxNumber: | 5203635611 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 TILBURY DRIVE | ||||||||
| Address2: | |||||||||
| City: | KEARNY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203635573 | ||||||||
| FaxNumber: | 5203635611 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2008 | ||||||||
| LastUpdateDate: | 03/05/2008 | ||||||||
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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 | 363LF0000X | AP2468 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.