Individual
ANNJALICA FERNANDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
25 KERI ANNE DR, BROCKTON, MA 02302-4179
(774) 240-1167
Mailing address
25 KERI ANNE DR, BROCKTON, MA 02302-4179
(774) 240-1167
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/05/2021
Last updated
03/05/2021
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