Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 124Q00000X | Dental Hygienist | H7864 | MN |
NPI | 1053565044 |
---|---|
Provider Name | Connie Karjalahti |
First Address | Coon Rapids, MN 55433-5852 |
Second Address | Coon Rapids, MN 55433-5852 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2008 |
Last Update Date | 20/11/2017 |