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Individual

TANISHA PENGEL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPN

Contact information

Practice address
10910 210TH ST, JAMAICA, NY 11429-1422
(610) 905-3352
Mailing address
10910 210TH ST, JAMAICA, NY 11429-1422

Taxonomy

Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
311323
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
311323
NY
Enumeration date
04/02/2017
Last updated
04/02/2017
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