Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | PHDH000548 | PA |
NPI | 1073991337 |
---|---|
Provider Name | Tracey Lee Hornak |
First Address | Spring Mills, PA 16875-8316 |
Second Address | Huntingdon, PA 16652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2015 |
Last Update Date | 07/05/2015 |