Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 020.006052 | IL |
NPI | 1063015998 |
---|---|
Provider Name | Maura O'connor Hellmich |
First Address | Palos Park, IL 60464-2058 |
Second Address | Palos Park, IL 60464-2058 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2020 |
Last Update Date | 22/11/2020 |