Provider Demographics
NPI:1316382468
Name:PENN, CHANDRA DENEE (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:CHANDRA
Middle Name:DENEE
Last Name:PENN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 DYEA AVE
Mailing Address - Street 2:UNIT D
Mailing Address - City:JBER
Mailing Address - State:AK
Mailing Address - Zip Code:99505-1123
Mailing Address - Country:US
Mailing Address - Phone:660-624-0264
Mailing Address - Fax:
Practice Address - Street 1:711 H ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3446
Practice Address - Country:US
Practice Address - Phone:907-770-0862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK35268163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse