Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 011592 | NY |
NPI | 1013937697 |
---|---|
Provider Name | Sheila Johnston |
First Address | Rochester, NY 14611-3634 |
Second Address | Rochester, NY 14608-1017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
011592 | (05) | NY |