Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist |
NPI | 1043281249 |
---|---|
Provider Name | Ms. Nekeia Remoan Roberson |
First Address | Suffolk, VA 23435-1077 |
Second Address | Portsmouth, VA 23709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 20/08/2007 |