Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 024715 | NY |
NPI | 1053985580 |
---|---|
Provider Name | Kristy L Powers |
First Address | Schenectady, NY 12307-1508 |
Second Address | Schenectady, NY 12307-1508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2021 |
Last Update Date | 19/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02995513 | (05) | NY |
331833 | OSCAR (01) | NY |
53099A | PIN (01) | NY |