Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | R07331 | IA |
NPI | 1225247497 |
---|---|
Provider Name | Jennifer Lynn Hadley-Kupfer |
First Address | Macy, NE 68039-0250 |
Second Address | Macy, NE 68039-0250 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |