Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 002023662 | CO |
NPI | 1073264081 |
---|---|
Provider Name | Mrs. Amanda Lynn Leonard |
First Address | Frederick, CO 80504-6766 |
Second Address | Frederick, CO 80504-6766 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2022 |
Last Update Date | 11/01/2022 |