Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH1453 | NM |
NPI | 1023134699 |
---|---|
Provider Name | Ms. Elizabeth Anne Ferrell |
First Address | Tijeras, NM 87059 |
Second Address | Albuquerque, NM 87104 |
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 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
72923733 | (05) | NM |