Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | RDA69709 | CA |
NPI | 1356972897 |
---|---|
Provider Name | Nicole Hammes |
First Address | Clovis, CA 93611-8976 |
Second Address | Clovis, CA 93611-8976 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2020 |
Last Update Date | 03/02/2020 |