Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | PHDH000862 | PA |
NPI | 1073162350 |
---|---|
Provider Name | Jessica Ann Brennan |
First Address | Behtlehem, PA 18015-1000 |
Second Address | Tamaqua, PA 18252-1927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2019 |
Last Update Date | 09/09/2019 |