Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | RDA80891 | CA |
NPI | 1124584115 |
---|---|
Provider Name | Jillian Anne Adney |
First Address | Visalia, CA 93292-3355 |
Second Address | Madera, CA 93636-8761 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2019 |
Last Update Date | 14/02/2019 |