Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 101521 | NV |
NPI | 1033758669 |
---|---|
Provider Name | Susan Aileen Davis |
First Address | Carson City, NV 89706-7913 |
Second Address | Las Vegas, NV 89104-4124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2019 |
Last Update Date | 30/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101521 | RDH LICENSE NUMBER (01) | NV |