Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 761 | ND |
NPI | 1073814497 |
---|---|
Provider Name | Mrs. Stacey Ann Sell |
First Address | Fargo, ND 58103-8712 |
Second Address | Fargo, ND 58103-8712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2010 |
Last Update Date | 17/11/2010 |