Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 1206 | NE |
NPI | 1033453931 |
---|---|
Provider Name | Jennifer Osborne |
First Address | Oneill, NE 68763-1852 |
Second Address | Oneill, NE 68763-1852 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2012 |
Last Update Date | 15/11/2012 |