Individual
SUSAN PENQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
18 FRANS WAY, SHELTON, CT 06484-2182
(516) 640-6195
Mailing address
18 FRANS WAY, SHELTON, CT 06484-2182
(516) 640-6195
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
10088
CT
Other
Enumeration date
02/23/2022
Last updated
02/23/2022
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