Individual
PASQUINA REVANCHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
315 BELAIR ST, BROCKTON, MA 02301-2029
(617) 849-0535
Mailing address
315 BELAIR ST, BROCKTON, MA 02301-2029
(617) 849-0535
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN94663
MA
Other
Enumeration date
03/13/2023
Last updated
03/13/2023
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