Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2021034208 | MO |
NPI | 1033860838 |
---|---|
Provider Name | Jaylee Evonne Mcginness |
First Address | White Cloud, KS 66094-4005 |
Second Address | Maryville, MO 64468-7473 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2022 |
Last Update Date | 12/01/2022 |