Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175F00000X | Naturopath | 953907 ABMP | CA |
Y | 225700000X | Massage Therapist | CLOVIS PERMIT | CA |
NPI | 1124280276 |
---|---|
Provider Name | Mrs. Laurie Catherine Dedmon |
First Address | Clovis, CA 93611-3402 |
Second Address | Clovis, CA 93611-3402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2008 |
Last Update Date | 30/06/2008 |