Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2013006314 | MO |
NPI | 1013687888 |
---|---|
Provider Name | Marlana Dawn Henning |
First Address | Clinton, MO 64735-8804 |
Second Address | Troy, MO 63379-3228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2021 |
Last Update Date | 14/09/2021 |