Provider Demographics
NPI:1528238672
Name:PENTELBURY, LAURENE (NP)
Entity type:Individual
Prefix:
First Name:LAURENE
Middle Name:
Last Name:PENTELBURY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TILBURY DRIVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:AZ
Mailing Address - Zip Code:85237
Mailing Address - Country:US
Mailing Address - Phone:520-363-5573
Mailing Address - Fax:520-363-5611
Practice Address - Street 1:100 TILBURY DRIVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:AZ
Practice Address - Zip Code:85237
Practice Address - Country:US
Practice Address - Phone:520-363-5573
Practice Address - Fax:520-363-5611
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2468363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily