Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 36835 | KY |
N | 207VG0400X | Gynecologist | 36835 | KY |
N | 207VX0000X | Obstetrician | 36835 | KY |
NPI | 1336184399 |
---|---|
Provider Name | Pamela R Midboe Penn |
First Address | Lexington, KY 40517-4012 |
Second Address | Lexington, KY 40536-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 07/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64033517 | (05) | KY |
F64617 | (02) |