Individual
AFI ASSIGNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3434 E WASHINGTON AVE, MADISON, WI 53704-4155
(608) 443-5482
Mailing address
7974 UW HEALTH CT, MIDDLETON, WI 53562-5531
(608) 829-5240
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
10999
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10999-16
STATE LICENS
WI
Enumeration date
06/30/2017
Last updated
06/30/2017
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