Individual
ELLAINA PENA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5515 W MARKET ST APT 906, GREENSBORO, NC 27409-2550
(336) 604-3283
Mailing address
5515 W MARKET ST APT 906, GREENSBORO, NC 27409-2550
(336) 604-3283
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
FDT1645
NC
Other
Enumeration date
04/29/2021
Last updated
05/24/2021
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