Individual
MRS. STEPHANIE M PENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
67 UNION STREET, SUITE 308, NATICK, MA 01760
(508) 655-4422
(508) 655-9191
Mailing address
67 UNION STREET, SUITE 308, NATICK, MA 01760
(508) 655-4422
(508) 655-9191
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
AP2050
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA-AP2561
PROVIDER ID NUMBER
MA
Enumeration date
03/21/2007
Last updated
06/26/2024
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