Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 01951 | NH |
NPI | 1013375070 |
---|---|
Provider Name | Michelle Blunden |
First Address | Nashua, NH 03060-3312 |
Second Address | Nashua, NH 03060-3312 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2016 |
Last Update Date | 05/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01951 | RDH LICENSE/ HYGENIST (01) | NH |