Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2902013519 | MI |
NPI | 1073943650 |
---|---|
Provider Name | Mrs. Sheilah Miller |
First Address | Hartford, MI 49057-9421 |
Second Address | Dowagiac, MI 49047-1762 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2013 |
Last Update Date | 19/11/2013 |