Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H05048 | AZ |
NPI | 1043860372 |
---|---|
Provider Name | Janett Hice |
First Address | Yuma, AZ 85364-6123 |
Second Address | Somerton, AZ 85350-8536 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2019 |
Last Update Date | 18/09/2019 |