Individual
EBONY SHARETTE PENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1720 SHADOW RIDGE CT APT H, BELLEVILLE, IL 62221-3914
(618) 409-3082
Mailing address
1720 SHADOW RIDGE CT APT H, BELLEVILLE, IL 62221-3914
(618) 409-3082
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209022466
IL
Other
Enumeration date
05/12/2021
Last updated
05/12/2021
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