Individual
MS. DOMINIQUE CHRYSTEL PENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 WATER ST APT 27, STOUGHTON, MA 02072-2866
(781) 975-4441
Mailing address
100 WATER ST APT 27, STOUGHTON, MA 02072-2866
(781) 975-4441
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN95762
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
—
01
—
NO
NO
—
Enumeration date
04/07/2021
Last updated
04/07/2021
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