Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 006937 | CT |
NPI | 1073639514 |
---|---|
Provider Name | Ms. Alisha Erickson |
First Address | Waterbury, CT 06705-1326 |
Second Address | Shelton, CT 06484-2804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 08/07/2007 |