Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1215232384 |
---|---|
Provider Name | Mrs. Judith Catherine Delvalle-Webb |
First Address | Sale,, NH 03079 |
Second Address | Salem, NH 03079-2145 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2011 |
Last Update Date | 20/01/2011 |