Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH009998 | GA |
NPI | 1013048370 |
---|---|
Provider Name | Mrs. Tracy Louise Coleman |
First Address | Apo Ae, NY 09244 |
Second Address | Apo Ae, NY 09244 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 08/07/2007 |