Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH5780 | MA |
NPI | 1053689208 |
---|---|
Provider Name | Mrs. Lynn Harrison |
First Address | Fairhaven, MA 02719-4131 |
Second Address | Fairhaven, MA 02719-4131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2011 |
Last Update Date | 02/12/2011 |