Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 13434 | MA |
NPI | 1013268002 |
---|---|
Provider Name | Elizabeth J Crocker |
First Address | Brewster, MA 02631-2429 |
Second Address | Brewster, MA 02631-2429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2012 |
Last Update Date | 01/10/2012 |