Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 020012480 | IL |
NPI | 1063889228 |
---|---|
Provider Name | Allison Winters |
First Address | Chicago, IL 60643-5851 |
Second Address | Chicago, IL 60643-5851 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2015 |
Last Update Date | 24/08/2015 |