Individual
JELESSA PENN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
43 LUCILLE ST., WAGGAMAN, LA 70094
(504) 376-5944
Mailing address
43 LUCILLE ST, WESTWEGO, LA 70094-5818
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000023890
LA
Other
Enumeration date
06/08/2017
Last updated
06/08/2017
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