Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist |
NPI | 1063661304 |
---|---|
Provider Name | Mrs. Dawn Elisha Manning |
First Address | Suffolk, VA 23434-9137 |
Second Address | Fpo, AE 09574-4664 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2008 |
Last Update Date | 11/09/2008 |