Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 60383 | KS |
NPI | 1144249145 |
---|---|
Provider Name | Miss Ellen Odette Remsing |
First Address | Manhattan, KS 66502 |
Second Address | Manhattan, KS 66503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000116960 | BLUE CROSS BLUE SHIELD (01) | KS |