Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 016556-1 | NY |
NPI | 1013081116 |
---|---|
Provider Name | Ms. Karen Allen |
First Address | Brockport, NY 14420-1118 |
Second Address | Brockport, NY 14420-1118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 08/07/2007 |