Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 004365 | NY |
NPI | 1003018953 |
---|---|
Provider Name | Eleanor Ann Spanek |
First Address | Utica, NY 13501-1930 |
Second Address | Rome, NY 13440-2129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2007 |
Last Update Date | 08/07/2007 |