Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 334 | CA |
NPI | 1033408125 |
---|---|
Provider Name | Luahna Ellner |
First Address | Mission Viejo, CA 92691-5814 |
Second Address | Mission Viejo, CA 92691-5814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2011 |
Last Update Date | 30/03/2011 |