Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 08000870A | IN |
NPI | 1538448584 |
---|---|
Provider Name | Dr. Penny Lou Ploch |
First Address | Evansville, IN 47714-7513 |
Second Address | Evansville, IN 47714-7513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2011 |
Last Update Date | 19/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08000870A | STATE OF IN PROFESSIONAL LICENSE (01) | IN |