Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 003614 | MO |
NPI | 1073785002 |
---|---|
Provider Name | Mrs. Leeanne Block |
First Address | Moberly, MO 65270 |
Second Address | Moberly, MO 65270-2222 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2008 |
Last Update Date | 31/03/2008 |