Individual
DARCY RAE PENNETTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1016 EUCLID AVE, CHARLOTTE, NC 28203-4520
(704) 807-5699
(704) 631-4574
Mailing address
9611 BROOKDALE DR, SUITE 100-122, CHARLOTTE, NC 28215-8719
(704) 807-5699
(704) 631-4574
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39296473
DRIVER'S LICENSE
NC
Enumeration date
03/10/2017
Last updated
03/10/2017
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