Basic Information
| Provider Information | |||||||||
| NPI: | 1598222127 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DRAZER | ||||||||
| FirstName: | PENNY | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6249 RIVERCLIFF LN | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454493048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374753128 | ||||||||
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| Practice Location | |||||||||
| Address1: | 540 LINCOLN PARK BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454296403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9379291117 | ||||||||
| FaxNumber: | 9372984728 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2019 | ||||||||
| LastUpdateDate: | 09/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 024367 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363A00000X | APRN.CNP.024367 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | F02191253 | 01 | AMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION BOARD | OTHER | 024367 | 01 | OH | APRN CERTIFIED NURSE PRACTITIONER | OTHER |