Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1326397746 |
---|---|
Provider Name | Tonia Lynn Hannaman |
First Address | Palisade, CO 81526-9745 |
Second Address | Grand Junction, CO 81501-6428 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2012 |
Last Update Date | 30/08/2012 |