Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1174079461 |
---|---|
Provider Name | Myrna Marcucci |
First Address | Apo, AE 09630 |
Second Address | Vicenza, ITALY 09630 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2016 |
Last Update Date | 28/08/2016 |