Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 722 | MT |
NPI | 1013401504 |
---|---|
Provider Name | Nancy Wimmer |
First Address | Miles City, MT 59301-8730 |
Second Address | Miles City, MT 59301-4757 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2018 |
Last Update Date | 18/06/2018 |