Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H6018 | MN |
NPI | 1013239359 |
---|---|
Provider Name | Mrs. Heather Glockle |
First Address | Minneapolis, MN 55413-2164 |
Second Address | Minneapolis, MN 55413-2164 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2010 |
Last Update Date | 26/02/2010 |