Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 013337 | MO |
NPI | 1144414400 |
---|---|
Provider Name | Dr. Nancy L. Newhouse |
First Address | Independence, MO 64055-6975 |
Second Address | Independence, MO 64055-6975 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2007 |
Last Update Date | 09/11/2010 |