Healthcare Provider Details

I. General information

NPI: 1699856427
Provider Name (Legal Business Name): JEFFRIE LYNN NORMOYLE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 MONTEVUE LN
FREDERICK MD
21702-8214
US

IV. Provider business mailing address

350 MONTEVUE LN
FREDERICK MD
21702-8214
US

V. Phone/Fax

Practice location:
  • Phone: 301-600-3114
  • Fax: 301-600-3111
Mailing address:
  • Phone: 301-600-3114
  • Fax: 301-600-3111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2010
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: