Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 57362 | CA |
NPI | 1003066689 |
---|---|
Provider Name | Katrina Elizabeth Perdue |
First Address | Red Bluff, CA 96080-8774 |
Second Address | Red Bluff, CA 96080-2372 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2008 |
Last Update Date | 18/03/2009 |