Provider Demographics
NPI:1730628751
Name:PENREE, ELISABETH RYAN (PA)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:RYAN
Last Name:PENREE
Suffix:
Gender:F
Credentials:PA
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:427 GUY PARK AVE
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-1064
Mailing Address - Country:US
Mailing Address - Phone:518-841-7237
Mailing Address - Fax:
Practice Address - Street 1:427 GUY PARK AVE
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-1064
Practice Address - Country:US
Practice Address - Phone:518-842-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant