Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 233166 |
NPI | 1144991191 |
---|---|
Provider Name | Paula Halifax |
First Address | Kansas City, MO 64131-1734 |
Second Address | Kansas City, MO 64131-1734 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2021 |
Last Update Date | 21/09/2021 |