Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1346840329 |
---|---|
Provider Name | Stephanie Danielle Rowe |
First Address | North Pole, AK 99705-6547 |
Second Address | Eielson Afb, AK 99702-2301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2020 |
Last Update Date | 28/10/2020 |