Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 11317 | KS |
N | 124Q00000X | Dental Hygienist | 5689 | TN |
N | 124Q00000X | Dental Hygienist | 7795 | AL |
NPI | 1043757677 |
---|---|
Provider Name | Karen Tolliver |
First Address | Fort Benning, GA 31905 |
Second Address | Fort Benning, GA 31905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2017 |
Last Update Date | 20/01/2017 |