Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 5444-16 | WI |
NPI | 1053752196 |
---|---|
Provider Name | Angela Jean Galloway |
First Address | Waukesha, WI 53188-9493 |
Second Address | Waukesha, WI 53188-9493 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2013 |
Last Update Date | 16/07/2013 |