Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2902004337 | MI |
NPI | 1043607716 |
---|---|
Provider Name | Mrs. Pamela Marie Jadwin |
First Address | Flint, MI 48503-2465 |
Second Address | Flint, MI 48503-2465 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2015 |
Last Update Date | 21/04/2015 |