Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 539 | CA |
NPI | 1083011837 |
---|---|
Provider Name | Annette S. Hannig |
First Address | Los Osos, CA 93402-2220 |
Second Address | Los Osos, CA 93402-2220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2014 |
Last Update Date | 20/05/2015 |