Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 0402203479 | VA |
NPI | 1003266859 |
---|---|
Provider Name | Vicky Bossie |
First Address | Fort Eustis, VA 23604-1526 |
Second Address | Fort Eustis, VA 23604-1526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2016 |
Last Update Date | 13/06/2016 |