Healthcare Provider Details

I. General information

NPI: 1306032271
Provider Name (Legal Business Name): MRS. MARJORIE MAE PENISON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

F26 ALGONQUIN TER
PLYMOUTH MA
02360-5421
US

IV. Provider business mailing address

F26 ALGONQUIN TER
PLYMOUTH MA
02360-5421
US

V. Phone/Fax

Practice location:
  • Phone: 508-591-7601
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: