Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 002849 | MO |
NPI | 1003930207 |
---|---|
Provider Name | Erin K Rickman |
First Address | Aurora, MO 65605-2621 |
Second Address | Fordland, MO 65652-7350 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 08/07/2007 |