Provider Demographics
NPI:1427718162
Name:PENUNURI, IVANNA (CMA)
Entity type:Individual
Prefix:
First Name:IVANNA
Middle Name:
Last Name:PENUNURI
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23615 108TH PL SE APT 1L305
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-5472
Mailing Address - Country:US
Mailing Address - Phone:253-348-4184
Mailing Address - Fax:
Practice Address - Street 1:723 SW 10TH ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5223
Practice Address - Country:US
Practice Address - Phone:206-461-4889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator