Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2010003568 | MO |
NPI | 1013285956 |
---|---|
Provider Name | Mrs. Chelsey Dawn Crocker |
First Address | Farmington, MO 63640-7387 |
Second Address | Farmington, MO 63640-7387 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2011 |
Last Update Date | 07/12/2011 |