Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 6642 | MD |
NPI | 1043562549 |
---|---|
Provider Name | Ms. Judy Lynn Forse |
First Address | Salisbury, MD 21802-1978 |
Second Address | Princess Anne, MD 21853-1358 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2012 |
Last Update Date | 19/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
119591300 | (05) | MD |