Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 30024122 | OH |
NPI | 1477819134 |
---|---|
Provider Name | Jane Annalise Walker |
First Address | Middletown, OH 45044-5513 |
Second Address | Middletown, OH 45044-5513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2012 |
Last Update Date | 06/02/2014 |