Provider Demographics
NPI:1386807519
Name:DEBUHR, PENNY DEE (DH)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:DEE
Last Name:DEBUHR
Suffix:
Gender:F
Credentials:DH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1789 ELM ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-3638
Mailing Address - Country:US
Mailing Address - Phone:563-690-2850
Mailing Address - Fax:563-557-8488
Practice Address - Street 1:1789 ELM ST
Practice Address - Street 2:SUITE A
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-3638
Practice Address - Country:US
Practice Address - Phone:563-690-2850
Practice Address - Fax:563-557-8488
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2952016172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33806800Medicaid
WI2952016OtherWISCONSIN LICENSE
IA03453OtherIOWA LICENSE