Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist | 3211082 | FL |
NPI | 1558029496 |
---|---|
Provider Name | Joanne Mullaney |
First Address | Crescent City, FL 32112-4521 |
Second Address | Crescent City, FL 32112-4521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2021 |
Last Update Date | 07/12/2021 |