Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 10576 | TX |
NPI | 1023230034 |
---|---|
Provider Name | Nancy Randall |
First Address | Arlington, TX 76011 |
Second Address | Arlington, TX 76011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |