Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | RDH3703 | ME |
NPI | 1073804928 |
---|---|
Provider Name | Nicki Clukey |
First Address | Ellsworth, ME 04605-3210 |
Second Address | Ellsworth, ME 04605-3210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2011 |
Last Update Date | 27/04/2011 |