Active NPI
Dominique Chrystel Penn
- Licensed Practical Nurse
- Stoughton, MA
National Provider Identifier
1871172619
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- LN95762
- Practice address
- 100 Water St Apt 27
Stoughton, MA 02072-2866 - Phone
- (781) 975-4441
- NPI assigned
- Apr 7, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | LN95762 | MA | Primary |
Addresses
Primary practice location
100 Water St Apt 27
Stoughton, MA 02072-2866
Mailing address
100 Water St Apt 27
Stoughton, MA 02072-2866
Phone (781) 975-4441
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NO | Other | NO | |
| NA | Other | NA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | stoughton | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LN95762 | MA | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1617753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617753600000",
"number": "1871172619",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 WATER ST APT 27",
"city": "STOUGHTON",
"state": "MA",
"postal_code": "020722866",
"telephone_number": "781-975-4441"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 WATER ST APT 27",
"city": "STOUGHTON",
"state": "MA",
"postal_code": "020722866",
"telephone_number": "781-975-4441"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENN",
"first_name": "DOMINIQUE",
"middle_name": "CHRYSTEL",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-07",
"last_updated": "2021-04-07",
"certification_date": "2021-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "MA",
"license": "LN95762",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NO",
"identifier": "NO",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NA",
"identifier": "NA",
"state": null
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "stoughton",
"affiliation": "N",
"endpointDescription": "office",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "dpenn@royalhealthgroup.com",
"address_1": "100 Water St Apt 27",
"city": "Stoughton",
"state": "MA",
"country_code": "US",
"postal_code": "020722866",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Stoughton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.