Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DH21242 | FL |
NPI | 1154885218 |
---|---|
Provider Name | Jennifer Manuel |
First Address | Tallahassee, FL 32301-1004 |
Second Address | Tallahassee, FL 32310-6123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2019 |
Last Update Date | 23/01/2019 |