Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 6569016 | WI |
NPI | 1073786687 |
---|---|
Provider Name | Amaris Ivette Estrada |
First Address | Waukesha, WI 53188-3771 |
Second Address | Waukesha, WI 53188-3771 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2008 |
Last Update Date | 04/04/2008 |