Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 124Q00000X | Dental Hygienist | AZ |
NPI | 1033708300 |
---|---|
Provider Name | Sherry Cline |
First Address | Peoria, AZ 85381-4362 |
Second Address | Peoria, AZ 85381-4362 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2021 |
Last Update Date | 12/01/2021 |