Hygeia - Provider: UpdateProfile

Update <ProviderName> Profile

First Name

First Name

Primary Specialty

Internist

Zip Code

12345

NPI Type

NPI Type

NPI Status

[ X ]Active [ ]Inactive

Credentials Status

[ ]Confirmed [ X ]Initiated

Last Name

First Name

Mobile Number

+1 (999) 888-7777

eMail Address

first.name@mailer.com

NPI

NPI

Company Name

Company Name

Credentials Confirmed Date

08/01/2020

Save

Portal

Google Sites

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