Doctor Name: | MRS. PENELOPE MASHBURN |
NPI Number: | 1154650117 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.O. |
License Number: | P12-00612 |
Business Practice Address: | 27 St. Lawrence Dr. Suite203 Tiffin, OH - 44883 |
Business Phone Number: | 3055759978 |
Business Fax Number: | 4194558564 |
Mailing Address: | 2200 Jefferson Ave, 4th Floor TOLEDO |
State: | OH |
Postal Code: | 436047101 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 12/21/2009 |
NPI Last Update Date: | 09/29/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | P12-00612 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NJ |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |