Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 102340 | NV |
NPI | 1013429554 |
---|---|
Provider Name | Brianna Ray Clancy |
First Address | Sun Valley, NV 89433-7826 |
Second Address | Sun Valley, NV 89433-7826 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2017 |
Last Update Date | 24/10/2017 |