Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | PHDH001210 | PA |
Y | 124Q00000X | Dental Hygienist | DH071683 | PA |
NPI | 1710653076 |
---|---|
Provider Name | Mrs. Kathryn Kelsey Herrmann |
First Address | Blossburg, PA 16912-0034 |
Second Address | Blossburg, PA 16912-1418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2021 |
Last Update Date | 18/08/2021 |