| Doctor Name: | PENNY MARIE SANDERSON |
| NPI Number: | 1013249929 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN, FNP-C |
| License Number: | 111108 |
| Business Practice Address: | 1517 Broadway Suite 124 Scottsbluff, NE - 693613184 |
| Business Phone Number: | 3086352800 |
| Business Fax Number: | 3086352801 |
| Mailing Address: | 1517 Broadway Ste 124, SCOTTSBLUFF |
| State: | NE |
| Postal Code: | 693613184 |
| Phone Number: | 3086352800 |
| Fax Number: | 3086352801 |
| NPI Enumeration Date: | 02/02/2010 |
| NPI Last Update Date: | 03/30/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 111108 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NE |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |