Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 3159 | NC |
NPI | 1013072826 |
---|---|
Provider Name | Mrs. Pattie Lucas Perez |
First Address | Ewa Beach, HI 96706-4755 |
Second Address | Honolulu, HI 96819 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3159 | HYGIENE LICENSE (01) | NC |