| Doctor Name: | JAMIE PENNY |
| NPI Number: | 1063835593 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | T8861753 |
| Business Practice Address: | 4881 Sugar Maple Dr 88th Mdos/sgomr Wpafb, OH - 454335529 |
| Business Phone Number: | 9372574159 |
| Business Fax Number: | |
| Mailing Address: | 4881 Sugar Maple Dr, 88th Mdos/sgomr WPAFB |
| State: | OH |
| Postal Code: | 454335529 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 02/04/2014 |
| NPI Last Update Date: | 02/04/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2471R0002X |
| License Number: | T8861753 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Radiologic Technologist |
| Taxonomy Specialization: | Radiation Therapy |
| Taxonomy Definition: | |