Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 018768-1 | NY |
NPI | 1013233618 |
---|---|
Provider Name | Ms. Glenda V Penoyer |
First Address | New Hartford, NY 13413-3613 |
Second Address | New Hartford, NY 13413-3613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2010 |
Last Update Date | 08/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00313539 | (05) | NY |
01815443 | (05) | NY |