Healthcare Provider Details

I. General information

NPI: 1043663636
Provider Name (Legal Business Name): VICKY J. NEHL RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11TH ABN DIV RD BLDG 3255
FORT BENNING GA
31905
US

IV. Provider business mailing address

11TH ABN DIV RD BLDG 3255
FORT BENNING GA
31905
US

V. Phone/Fax

Practice location:
  • Phone: 706-544-9071
  • Fax:
Mailing address:
  • Phone: 706-544-9071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH006903
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: