Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | RDH-03881 | IA |
NPI | 1023481223 |
---|---|
Provider Name | Stephanie Chamberlin |
First Address | Waterloo, IA 50703-4407 |
Second Address | Waterloo, IA 50703-4407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2015 |
Last Update Date | 10/11/2015 |