Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 0402003911 | VA |
NPI | 1033407390 |
---|---|
Provider Name | Amy W Hartman |
First Address | Franktown, VA 23354 |
Second Address | Franktown, VA 23354 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2011 |
Last Update Date | 20/07/2011 |