Individual
SHANNON MARY DICENSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
12 GLENSIDE DR, BLACKSTONE, MA 01504-1548
(617) 201-6759
Mailing address
12 GLENSIDE DR, BLACKSTONE, MA 01504-1548
(617) 201-6759
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN89314
MA
Other
Enumeration date
03/22/2024
Last updated
03/22/2024
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