Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH005014L | PA |
NPI | 1043709488 |
---|---|
Provider Name | Mrs. Nancy Louise Ryder |
First Address | Muncy, PA 17756-7290 |
Second Address | Muncy, PA 17756-7290 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2018 |
Last Update Date | 01/05/2018 |