Provider Demographics
NPI:1962803957
Name:PENREE, WILLIAM (LPN)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:PENREE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 COLONIAL CIR
Mailing Address - Street 2:APT 2Q
Mailing Address - City:ILION
Mailing Address - State:NY
Mailing Address - Zip Code:13357-4343
Mailing Address - Country:US
Mailing Address - Phone:315-679-1156
Mailing Address - Fax:
Practice Address - Street 1:117 COLONIAL CIR
Practice Address - Street 2:APT 2Q
Practice Address - City:ILION
Practice Address - State:NY
Practice Address - Zip Code:13357-4343
Practice Address - Country:US
Practice Address - Phone:315-679-1156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10 315565164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse