Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 4895 | AZ |
NPI | 1053841882 |
---|---|
Provider Name | Mrs. Miquel Mcrae |
First Address | Pima, AZ 85543-0937 |
Second Address | Pima, AZ 85543 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2017 |
Last Update Date | 14/06/2017 |