Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 5413-16 | WI |
NPI | 1073821278 |
---|---|
Provider Name | Anita Lynn Behm |
First Address | Fond Du Lac, WI 54935-4241 |
Second Address | Fond Du Lac, WI 54935-4241 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2010 |
Last Update Date | 22/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38397700 | (05) | WI |