Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH3681 | NM |
NPI | 1013540848 |
---|---|
Provider Name | Kelsi Marie Hartwig |
First Address | Shiprock, NM 87420-0160 |
Second Address | Shiprock, NM 87420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2020 |
Last Update Date | 20/02/2020 |