Provider Demographics
NPI:1124708664
Name:PENNY, LASHAE NICOLE
Entity type:Individual
Prefix:
First Name:LASHAE
Middle Name:NICOLE
Last Name:PENNY
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 1:17811 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3062
Mailing Address - Country:US
Mailing Address - Phone:586-238-6923
Mailing Address - Fax:
Practice Address - Street 1:17811 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3062
Practice Address - Country:US
Practice Address - Phone:586-238-6923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty