Provider Demographics
NPI:1144524026
Name:DRY, PENNY JELAN (RN)
Entity type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:JELAN
Last Name:DRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6309 88TH ST NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-2858
Mailing Address - Country:US
Mailing Address - Phone:360-653-3474
Mailing Address - Fax:
Practice Address - Street 1:14643 NE 166TH ST
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-9013
Practice Address - Country:US
Practice Address - Phone:425-806-9453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00164631163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics