Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist |
NPI | 1013367424 |
---|---|
Provider Name | Betsy Richardson |
First Address | Fort Eustis, VA 23604-1526 |
Second Address | Virginia Beach, VA 23451-8124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2016 |
Last Update Date | 17/06/2016 |