Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH00005545 | WA |
NPI | 1073789442 |
---|---|
Provider Name | Gail Ann Heacox |
First Address | Spokane, WA 99224-5092 |
Second Address | Spokane, WA 99224-5092 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2008 |
Last Update Date | 05/05/2008 |