Provider Demographics
NPI:1124503610
Name:PENNEPACKER, DAWN RENE
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:RENE
Last Name:PENNEPACKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N EL CAMINO REAL SPC 317
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-0821
Mailing Address - Country:US
Mailing Address - Phone:760-696-2282
Mailing Address - Fax:
Practice Address - Street 1:935 W SAN MARCOS BLVD STE 103
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-1142
Practice Address - Country:US
Practice Address - Phone:760-471-3705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist