Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 3646 | NV |
NPI | 1013216340 |
---|---|
Provider Name | Ms. Susan E Legrand |
First Address | Las Vegas, NV 89102-7490 |
Second Address | Las Vegas, NV 89102-7490 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2011 |
Last Update Date | 01/03/2012 |