Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | L.D. 43 | ID |
NPI | 1184870107 |
---|---|
Provider Name | Ms. Jacqueline Kay Neff |
First Address | Coeur D Alene, ID 83814-3216 |
Second Address | Coeur D Alene, ID 83814-3216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2008 |
Last Update Date | 10/08/2008 |