Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 82315866 | FL |
NPI | 1275016008 |
---|---|
Provider Name | Monae Grey |
First Address | Riverview, FL 33578-3125 |
Second Address | Riverview, FL 33578-3125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2018 |
Last Update Date | 07/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NA | CRANIAL PROSTHESIS (01) | FL |