Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 124Q00000X | Dental Hygienist | 020015623 | IL |
Y | 124Q00000X | Dental Hygienist | 2016025847 | MO |
NPI | 1053968586 |
---|---|
Provider Name | Lindsey Marie Pyse |
First Address | Saint Charles, MO 63301-2894 |
Second Address | Hannibal, MO 63401-3670 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2019 |
Last Update Date | 20/08/2019 |