Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist |
NPI | 1003440843 |
---|---|
Provider Name | Anna Nguyen |
First Address | Festus, MO 63028-1952 |
Second Address | Arnold, MO 63010-1409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2020 |
Last Update Date | 02/03/2020 |