Provider Demographics
NPI:1588265995
Name:HINDERS, PENNY REANNE (LVN)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:REANNE
Last Name:HINDERS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 SPEIGHT AVE APT 121
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76706-1419
Mailing Address - Country:US
Mailing Address - Phone:210-639-8056
Mailing Address - Fax:
Practice Address - Street 1:817 SPEIGHT AVE APT 121
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76706-1419
Practice Address - Country:US
Practice Address - Phone:210-639-8056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX170120164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse