Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist |
NPI | 1003453564 |
---|---|
Provider Name | Cynthia A Baus |
First Address | Sheboygan, WI 53082-0959 |
Second Address | Sheboygan, WI 53081-2342 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2019 |
Last Update Date | 04/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3459 | LICENSE (01) | WI |