Individual
LOWELLA JEAN DOMENECH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
132 W CHURCH ST, VENEDY, IL 62214-1254
(618) 824-6229
Mailing address
132 W CHURCH ST, VENEDY, IL 62214-1254
(618) 824-6229
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
06/12/2021
Last updated
06/12/2021
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