Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH22275 | FL |
NPI | 1043564289 |
---|---|
Provider Name | Summer Suzanne Delille |
First Address | Fernandina Beach, FL 32034 |
Second Address | Fernandina Beach, FL 32034 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2012 |
Last Update Date | 08/11/2012 |