Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 15510 | TX |
NPI | 1003046368 |
---|---|
Provider Name | Miss Stephanie Michelle Irwin |
First Address | Crowley, TX 76036-3665 |
Second Address | Crowley, TX 76036-3665 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2009 |
Last Update Date | 21/07/2009 |