Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 12348 | NC |
NPI | 1033761168 |
---|---|
Provider Name | Sydnee Rivera |
First Address | Virginia Beach, VA 23462-4670 |
Second Address | Fpo, AP 96692 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2019 |
Last Update Date | 09/07/2019 |