Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2902004726 | MI |
NPI | 1073764882 |
---|---|
Provider Name | Mary Crisher |
First Address | Battle Creek, MI 49037-7314 |
Second Address | Battle Creek, MI 49037-7314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2008 |
Last Update Date | 10/10/2008 |