Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist |
NPI | 1063911063 |
---|---|
Provider Name | Mrs. Cheryl Ann Poniewierski |
First Address | Almont, MI 48003-0446 |
Second Address | Almont, MI 48003-8553 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2018 |
Last Update Date | 05/02/2018 |