Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 026683 | NY |
NPI | 1073899555 |
---|---|
Provider Name | Ms. Andrea L Sellan |
First Address | Lackawanna, NY 14218-1629 |
Second Address | Lackawanna, NY 14218-1629 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2011 |
Last Update Date | 27/10/2011 |