Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist |
NPI | 1043515042 |
---|---|
Provider Name | Mrs. Jamie Goodwin |
First Address | Coeur D' Alene, ID 83816 |
Second Address | Coeur D Alene, ID 83814-2570 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2011 |
Last Update Date | 21/01/2011 |