Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2902019649 | MI |
NPI | 1003577917 |
---|---|
Provider Name | Miss Olivia Rae Arellano |
First Address | Baldwin, MI 49304-9406 |
Second Address | Cadillac, MI 49601-2588 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2022 |
Last Update Date | 03/01/2022 |