Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1164873949 |
---|---|
Provider Name | Jade C Ferreira |
First Address | Tripler Amc, HI 96859-5000 |
Second Address | Tripler Amc, HI 96859-5000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2016 |
Last Update Date | 23/06/2016 |