Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 5337 | MA |
NPI | 1003212838 |
---|---|
Provider Name | Louise Nally |
First Address | Hubbardston, MA 01452-1419 |
Second Address | Hubbardston, MA 01452-1419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2014 |
Last Update Date | 05/11/2014 |