Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 1001844-15 | WI |
NPI | 1154813954 |
---|---|
Provider Name | Chandler Roemer |
First Address | Hayward, WI 54843-7894 |
Second Address | Hayward, WI 54843-7894 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2018 |
Last Update Date | 31/03/2021 |