Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 1051 | MT |
NPI | 1003002791 |
---|---|
Provider Name | Elizabeth Mary Rolle |
First Address | Missoula, MT 59804-2938 |
Second Address | Missoula, MT 59802-4123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2007 |
Last Update Date | 17/09/2007 |