Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH802 | NM |
NPI | 1033289657 |
---|---|
Provider Name | Mrs. Deirdre S Herzer |
First Address | Albuquerque, NM 87106-2243 |
Second Address | Albuquerque, NM 87106-2243 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1800372 | UNITED CONCORDIA (01) |