Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 223698 | KY |
NPI | 1104351253 |
---|---|
Provider Name | Carolyn Dunn |
First Address | Lexington, KY 40504-3150 |
Second Address | Lexington, KY 40504-3150 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2017 |
Last Update Date | 26/04/2017 |