Individual
MASHICA PENNYWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
233 SUZANNE DR, SHREVEPORT, LA 71115-2619
(318) 207-4386
Mailing address
233 SUZANNE DR, SHREVEPORT, LA 71115-2619
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN150854
LA
Other
Enumeration date
03/20/2025
Last updated
03/20/2025
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