Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 6025 | AZ |
NPI | 1053420687 |
---|---|
Provider Name | Lisa Marie Murphy |
First Address | Pine, AZ 85544-1566 |
Second Address | Payson, AZ 85541-3607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 08/07/2007 |