Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 6374-15 | WI |
NPI | 1053604777 |
---|---|
Provider Name | Dr. Jane Wright |
First Address | Kenosha, WI 53142-4181 |
Second Address | Kenosha, WI 53142-4181 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2011 |
Last Update Date | 27/05/2011 |