Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 60210636 | WA |
NPI | 1013486760 |
---|---|
Provider Name | Joylene Rochelle Neils |
First Address | University Place, WA 98466-7545 |
Second Address | Tacoma, WA 98406-5450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2018 |
Last Update Date | 23/11/2018 |