Individual
CHOUPETTE DORALUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
258 BROADWAY, MALDEN, MA 02148-4525
(857) 888-1014
Mailing address
258 BROADWAY APT 2, MALDEN, MA 02148-4525
(857) 888-1012
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
S62901986
MA
Other
Enumeration date
04/26/2012
Last updated
04/26/2012
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