Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 1564 | NH |
NPI | 1073905592 |
---|---|
Provider Name | Lynette Vignola |
First Address | Pelham, NH 03076-3400 |
Second Address | Pelham, NH 03076-3400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2015 |
Last Update Date | 20/02/2015 |