Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH7954 | MA |
NPI | 1023523438 |
---|---|
Provider Name | Maryellen Robillard |
First Address | Pembroke, MA 02359-1848 |
Second Address | Hingham, MA 02043-4258 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2017 |
Last Update Date | 07/12/2017 |