Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CFM00608 | DE |
NPI | 1336235381 |
---|---|
Provider Name | Ms. Shellie L. Cruz |
First Address | Grand Island, NE 68803-3120 |
Second Address | Hastings, NE 68901-3200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |