Individual
JESSICA LIDIETH MAIRENA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
957 ALLEN PARK LN, AYDEN, NC 28513-0300
(281) 250-6324
Mailing address
957 ALLEN PARK LN, AYDEN, NC 28513-0300
(281) 250-6324
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
07/25/2022
Last updated
07/25/2022
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