Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 635 | AK |
NPI | 1013287283 |
---|---|
Provider Name | Angela C Mckinney |
First Address | Seward, AK 99664-2088 |
Second Address | Seward, AK 99664-2088 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2012 |
Last Update Date | 05/01/2012 |