Provider Demographics
NPI:1083429419
Name:PENROSE, BRIANNE (RN)
Entity type:Individual
Prefix:
First Name:BRIANNE
Middle Name:
Last Name:PENROSE
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 E SHERRI DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3408
Mailing Address - Country:US
Mailing Address - Phone:480-765-3638
Mailing Address - Fax:
Practice Address - Street 1:828 S VALENCIA
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-2824
Practice Address - Country:US
Practice Address - Phone:480-472-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ310368163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse