Individual
CLYTENDRE JEAN-MICHEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
49 THEODORE ST, DORCHESTER, MA 02124-4090
(617) 943-5173
Mailing address
49 THEODORE ST, DORCHESTER, MA 02124-4090
(617) 943-5173
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN101447
MA
Other
Enumeration date
09/29/2023
Last updated
09/29/2023
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