Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 022770 | NY |
NPI | 1003147737 |
---|---|
Provider Name | Jennifer Walker |
First Address | Albany, NY 12208-1708 |
Second Address | Albany, NY 12208-1708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2010 |
Last Update Date | 20/01/2010 |