Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | IL |
NPI | 1063428142 |
---|---|
Provider Name | Maria L Connoyer |
First Address | Quincy, IL 62301-3119 |
Second Address | Quincy, IL 62301-3119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 08/07/2007 |