Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 07-041-DHAT | AK |
NPI | 1023385580 |
---|---|
Provider Name | Rochelle Selene Ferry |
First Address | Nome, AK 99762-0966 |
Second Address | Nome, AK 99762 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2011 |
Last Update Date | 28/11/2011 |