Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 5328674-9920 | UT |
NPI | 1023537156 |
---|---|
Provider Name | Brenda Fuell |
First Address | Riverton, UT 84065-6933 |
Second Address | Riverton, UT 84065 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2017 |
Last Update Date | 09/09/2017 |