Provider Demographics
NPI:1144521196
Name:PENNO, RUTH (FNP-C, CDE)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:
Last Name:PENNO
Suffix:
Gender:F
Credentials:FNP-C, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17779
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85269-7779
Mailing Address - Country:US
Mailing Address - Phone:480-789-7890
Mailing Address - Fax:480-789-7894
Practice Address - Street 1:19829 N 27TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4001
Practice Address - Country:US
Practice Address - Phone:623-879-1889
Practice Address - Fax:623-879-5266
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3697363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily