Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 903535 | CO |
NPI | 1073693891 |
---|---|
Provider Name | Peggy Jo Irby |
First Address | Pueblo, CO 81001-1405 |
Second Address | Pueblo, CO 81008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 27/07/2016 |