Individual
MRS. OCTAVIA DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
70 HIGHLAND PARK DR, LEVITTOWN, PA 19056-1338
(908) 954-8942
Mailing address
70 HIGHLAND PARK DR, LEVITTOWN, PA 19056-1338
(908) 954-8942
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN309164
PA
Other
Enumeration date
07/09/2020
Last updated
07/09/2020
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