Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH1521 | NM |
NPI | 1063929503 |
---|---|
Provider Name | Jo Ann Mccauley |
First Address | Carlsbad, NM 88221-3087 |
Second Address | Carlsbad, NM 88220-6212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2018 |
Last Update Date | 05/01/2018 |