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Individual

MS. AUTUMN BRESHAWN PANNKUK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1395 BAYSIDE DR, EDGEWATER, MD 21037-4421
(951) 283-8174
Mailing address
1395 BAYSIDE DR, EDGEWATER, MD 21037-4421
(951) 283-8174

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
MD

Other

Enumeration date
04/16/2020
Last updated
04/16/2020
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