Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 3631 | WI |
NPI | 1013155589 |
---|---|
Provider Name | Betsy A. Ness |
First Address | Wausau, WI 54401-4226 |
Second Address | Wausau, WI 54401-4226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2009 |
Last Update Date | 21/01/2009 |