Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 002743 | IL |
NPI | 1063965812 |
---|---|
Provider Name | Geralynn Huffman |
First Address | Park Ridge, IL 60068-2554 |
Second Address | Park Ridge, IL 60068-2554 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2016 |
Last Update Date | 28/07/2016 |