Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 124Q00000X | Dental Hygienist | 0013731 | TX |
Y | 124Q00000X | Dental Hygienist | DH-1566 | HI |
NPI | 1073884060 |
---|---|
Provider Name | Christel Marie Hornstra |
First Address | Fort Carson, CO 80913-4095 |
Second Address | Fort Carson, CO 80913-4095 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2012 |
Last Update Date | 23/01/2012 |