Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 4452-016 | WI |
NPI | 1043466196 |
---|---|
Provider Name | Diane E Kosar |
First Address | Kenosha, WI 53140-5917 |
Second Address | Kenosha, WI 53140-5917 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2008 |
Last Update Date | 08/08/2008 |