Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 01523 | NH |
N | 124Q00000X | Dental Hygienist | DH5053 | MA |
NPI | 1013300359 |
---|---|
Provider Name | Nancy Lee Kelley |
First Address | Hampton, NH 03842-3318 |
Second Address | Hampton, NH 03842-3318 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2015 |
Last Update Date | 11/03/2015 |