Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 5256-015 | WI |
NPI | 1003824525 |
---|---|
Provider Name | Dr. Heather Rose Reyerson |
First Address | La Crosse, WI 54601-5202 |
Second Address | La Crosse, WI 54603-1973 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 08/07/2007 |