Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2016018884 | MO |
NPI | 1013455666 |
---|---|
Provider Name | Jami Hedrick |
First Address | Ellington, MO 63638-9400 |
Second Address | Pilot Knob, MO 63663 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2017 |
Last Update Date | 02/08/2017 |