| Doctor Name: | DANETTE PENGILLY |
| NPI Number: | 1013016989 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | GNP-C |
| License Number: | R23780 |
| Business Practice Address: | 310 N 10th St Bismarck, ND - 585014516 |
| Business Phone Number: | 7015307500 |
| Business Fax Number: | 7015307484 |
| Mailing Address: | 310 N 10th St, BISMARCK |
| State: | ND |
| Postal Code: | 585014516 |
| Phone Number: | 7015307500 |
| Fax Number: | 7015307484 |
| NPI Enumeration Date: | 09/21/2006 |
| NPI Last Update Date: | 02/29/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | R23780 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ND |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |