Individual
SHELLY J WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6704 JACOBS WAY, MADISON, WI 53711-3254
(608) 576-1573
Mailing address
6704 JACOBS WAY, MADISON, WI 53711-3254
(608) 576-1573
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
9735-16
WI
163W00000X
Registered Nurse
Primary
177798-30
WI
Other
Enumeration date
09/04/2023
Last updated
09/04/2023
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