Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH21604 | FL |
NPI | 1073911582 |
---|---|
Provider Name | Lisa Hermes |
First Address | Apo, AE 09112-8038 |
Second Address | Apo, AE 09112-8038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2014 |
Last Update Date | 16/12/2014 |