Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2902012570 | MI |
NPI | 1043733058 |
---|---|
Provider Name | Nancy Warner |
First Address | Detroit, MI 48216-2200 |
Second Address | Detroit, MI 48236-2058 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2017 |
Last Update Date | 21/07/2017 |